Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Acute colonic pseudo-obstruction (Ogilvie's syndrome)

Michael Camilleri, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Pseudo-obstruction is characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of a mechanical cause. Pseudo-obstruction may be acute or chronic and is characterized by the presence of dilation of the bowel on imaging. Other causes of colonic distension including toxic megacolon, mechanical obstruction, and chronic intestinal pseudo-obstruction are discussed in detail, separately. (See "Overview of mechanical colorectal obstruction" and "Toxic megacolon" and "Chronic intestinal pseudo-obstruction".)


Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a disorder characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents.


Acute colonic pseudo-obstruction usually occurs in hospitalized or institutionalized patients in association with a severe illness or after surgery and in conjunction with a metabolic imbalance or administration of culprit medication (table 1) [1-4]. In a large, retrospective series that included 400 patients with acute colonic pseudo-obstruction, the most common predisposing conditions were nonoperative trauma, infection, and cardiac disease, each of which were associated with 10 percent of cases [1]. In this series, cesarean section and hip surgery were the most common surgical procedures associated with acute colonic pseudo-obstruction.


Acute colonic pseudo-obstruction usually involves the cecum and right hemicolon, although occasionally colonic dilation extends to the rectum. Acute colonic pseudo-obstruction appears to be more common in men and in patients over the age of 60 years [1]. However, cases have been reported in children [5]. Acute colonic pseudo-obstruction is a rare complication of surgery, occurring in 0.06 percent of patients after cardiac surgery, 0.29 percent of burn patients, and 0.7 to 1.3 percent of patients after orthopedic surgery [4,6]. In surgical patients, symptoms usually present at an average of five days postoperatively.


The precise mechanism by which colonic dilation occurs in patients with acute colonic pseudo-obstruction is unknown. The association with trauma, spinal anesthesia, and pharmacologic agents suggests an impairment of the autonomic nervous system. Interruption of the parasympathetic fibers from S2 to S4 leaves an atonic distal colon and a functional proximal obstruction [1,7]. However, there is no proposed mechanism to explain colonic dilation in those patients without obvious involvement of the parasympathetic nerves.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: May 2017. | This topic last updated: Mar 26, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum 1986; 29:203.
  2. Delmer A, Cymbalista F, Bauduer F, et al. Acute colonic pseudo-obstruction (Ogilvie's syndrome) during induction treatment with chemotherapy and all-trans-retinoic acid for acute promyelocytic leukemia. Am J Hematol 1995; 49:97.
  3. Xie H, Peereboom DM. Ogilvie's syndrome during chemotherapy with high-dose methotrexate for primary CNS lymphoma. J Clin Oncol 2012; 30:e192.
  4. Johnston G, Vitikainen K, Knight R, et al. Changing perspective on gastrointestinal complications in patients undergoing cardiac surgery. Am J Surg 1992; 163:525.
  5. Lee JW, Bang KW, Jang PS, et al. Neostigmine for the treatment of acute colonic pseudo-obstruction (ACPO) in pediatric hematologic malignancies. Korean J Hematol 2010; 45:62.
  6. Norwood MG, Lykostratis H, Garcea G, Berry DP. Acute colonic pseudo-obstruction following major orthopaedic surgery. Colorectal Dis 2005; 7:496.
  7. Ogilvie WH. William Heneage Ogilvie 1887-1971. Large-intestine colic due to sympathetic deprivation. A new clinical syndrome. Dis Colon Rectum 1987; 30:984.
  8. Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol 2007; 21:671.
  9. Johnson CD, Rice RP, Kelvin FM, et al. The radiologic evaluation of gross cecal distension: emphasis on cecal ileus. AJR Am J Roentgenol 1985; 145:1211.
  10. Sloyer AF, Panella VS, Demas BE, et al. Ogilvie's syndrome. Successful management without colonoscopy. Dig Dis Sci 1988; 33:1391.
  11. Jetmore AB, Timmcke AE, Gathright JB Jr, et al. Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors. Dis Colon Rectum 1992; 35:1135.
  12. Simon M, Duong JP, Mallet V, et al. Over-expression of colonic K+ channels associated with severe potassium secretory diarrhoea after haemorrhagic shock. Nephrol Dial Transplant 2008; 23:3350.
  13. Sandle GI, Hunter M. Apical potassium (BK) channels and enhanced potassium secretion in human colon. QJM 2010; 103:85.
  14. Schermer CR, Hanosh JJ, Davis M, Pitcher DE. Ogilvie's syndrome in the surgical patient: a new therapeutic modality. J Gastrointest Surg 1999; 3:173.
  15. ASGE Standards of Practice Committee, Harrison ME, Anderson MA, et al. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71:669.
  16. Weinstock LB, Chang AC. Methylnaltrexone for treatment of acute colonic pseudo-obstruction. J Clin Gastroenterol 2011; 45:883.
  17. Eisen GM, Baron TH, Dominitz JA, et al. Acute colonic pseudo-obstruction. Gastrointest Endosc 2002; 56:789.
  18. Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther 2005; 22:917.
  19. Sgouros SN, Vlachogiannakos J, Vassiliadis K, et al. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut 2006; 55:638.
  20. Korsten MA, Rosman AS, Ng A, et al. Infusion of neostigmine-glycopyrrolate for bowel evacuation in persons with spinal cord injury. Am J Gastroenterol 2005; 100:1560.
  21. Rausch ME, Troiano NH, Rosen T. Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy. J Perinatol 2007; 27:244.
  22. Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med 1999; 341:137.
  23. Vantrappen G. Acute colonic pseudo-obstruction. Lancet 1993; 341:152.
  24. Rex DK. Acute colonic pseudo-obstruction (Ogilvie's syndrome). Gastroenterologist 1994; 2:233.
  25. Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc 1996; 44:144.
  26. vanSonnenberg E, Varney RR, Casola G, et al. Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience. Radiology 1990; 175:679.
  27. Cowlam S, Watson C, Elltringham M, et al. Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc 2007; 65:1007.
  28. Ramage JI Jr, Baron TH. Percutaneous endoscopic cecostomy: a case series. Gastrointest Endosc 2003; 57:752.
  29. Saunders MD, Kimmey MB. Colonic pseudo-obstruction: the dilated colon in the ICU. Semin Gastrointest Dis 2003; 14:20.
  30. De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg 2009; 96:229.
  31. Bonacini M, Smith OJ, Pritchard T. Erythromycin as therapy for acute colonic pseudo-obstruction (Ogilvie's syndrome). J Clin Gastroenterol 1991; 13:475.
  32. Armstrong DN, Ballantyne GH, Modlin IM. Erythromycin for reflex ileus in Ogilvie's syndrome. Lancet 1991; 337:378.
  33. DAVIS L, LOWMAN RM. An evaluation of cecal size in impending perforation of the cecum. Surg Gynecol Obstet 1956; 103:711.