Acute colonic pseudo-obstruction (Ogilvie's syndrome)
- Michael Camilleri, MD
Michael Camilleri, MD
- Professor of Medicine, Pharmacology, and Physiology
- Mayo Clinic College of Medicine
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) [1-5]. 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 . In this series, cesarean section and hip surgery were the most common surgical procedures associated with acute colonic pseudo-obstruction. In a systematic review of 125, postpartum cases of acute colonic pseudo-obstruction 62 (92 percent) occurred following caesarian section for varying indications including preeclampsia, multiple pregnancy, and antepartum hemorrhage/placenta previa . No specific risk factors could be identified for postpartum acute colonic pseudo-obstruction. In this review, 43 percent of patients had intestinal perforation or impending perforation, and 47 percent of patients required laparotomy, whereas conservative management was successful in 50 percent of cases. All patients with a cecal diameter of >12 cm perforated as compared to 3 of 17 patients with a diameter of <9 cm. Most perforations were diagnosed between day 3 and day 5 following the caesarian section.
Acute colonic pseudo-obstruction is also well-documented after kidney transplantation, and possible contributing factors include obesity, cumulative dose of prednisone received, and mycophenolate mofetil .
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 . However, cases have been reported in children . 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 [4,9]. In surgical patients, symptoms usually present at an average of five days postoperatively. From a national hospital admissions database, the calculated incidence of acute colonic pseudo-obstruction is approximately 100 cases out of 100,000 inpatient admissions per year .
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- CLINICAL MANIFESTATIONS
- - Laboratory tests
- - Imaging
- DIFFERENTIAL DIAGNOSIS
- Mechanical obstruction
- Toxic megacolon
- Approach to management
- Supportive care
- Other pharmacological approaches
- Nonsurgical decompression
- - Colonoscopic decompression
- - Percutaneous decompression
- SUMMARY AND RECOMMENDATIONS