Ogilvie syndrome

Acute colonic pseudo-obstruction

Ogilvie syndrome
Synonyms	Acute colonic pseudo-obstruction
Pronounce
Field	Gastroenterology, Surgery
Symptoms	Abdominal distension, pain, nausea, vomiting, constipation, absent bowel movements
Complications	Bowel ischemia, colonic perforation, sepsis
Onset	Sudden
Duration	Variable; can be acute or prolonged
Types
Causes	Dysregulation of autonomic nervous system, often triggered by trauma, surgery, infection, or medications
Risks	Hospitalization, trauma, major surgery, electrolyte imbalances, use of opioids or anticholinergic medications
Diagnosis	Abdominal X-ray, CT scan, exclusion of mechanical obstruction
Differential diagnosis	Mechanical bowel obstruction, Toxic megacolon, Volvulus
Prevention	Minimize use of causative medications, early mobilization post-surgery
Treatment	Bowel rest, decompression with rectal tube or colonoscopy, neostigmine in refractory cases
Medication	Neostigmine (cholinesterase inhibitor)
Prognosis	Generally good with timely management; risk of complications if delayed
Frequency	Rare
Deaths	Associated with delayed diagnosis and complications such as perforation

Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is a condition characterized by the acute dilation of the colon in the absence of any mechanical obstruction. It is named after Sir William Heneage Ogilvie, who first described the syndrome in 1948.

Pathophysiology

Ogilvie syndrome is thought to result from an imbalance in the autonomic nervous system, which leads to a dysfunction in the colonic motility. The exact mechanism is not fully understood, but it is believed that there is an excessive sympathetic nervous system activity or a lack of parasympathetic activity, leading to colonic atony and dilation.

Causes

Ogilvie syndrome can occur in a variety of clinical settings. It is often associated with:

• Trauma
• Infection
• Surgery, particularly abdominal or pelvic surgery
• Neurological disorders such as Parkinson's disease or multiple sclerosis
• Electrolyte imbalances, such as hypokalemia or hypercalcemia
• Use of certain medications, including opioids and anticholinergics

Symptoms

The symptoms of Ogilvie syndrome are similar to those of a mechanical bowel obstruction and may include:

• Abdominal distension
• Abdominal pain
• Nausea and vomiting
• Constipation or inability to pass gas

Diagnosis

The diagnosis of Ogilvie syndrome is primarily clinical, supported by imaging studies. A plain abdominal X-ray or CT scan can show colonic dilation without evidence of mechanical obstruction. It is important to rule out true mechanical obstruction, which may require surgical intervention.

Treatment

The management of Ogilvie syndrome involves both conservative and pharmacological approaches:

Conservative Management

• Bowel rest and nasogastric decompression
• Correction of any underlying electrolyte imbalances
• Discontinuation of medications that may contribute to colonic atony

Pharmacological Treatment

• Administration of neostigmine, a cholinesterase inhibitor, can stimulate colonic motility and is often effective in resolving the condition.

Surgical Intervention

In cases where conservative and pharmacological treatments fail, or if there is evidence of colonic ischemia or perforation, surgical intervention may be necessary. This can include colonoscopy for decompression or, in severe cases, surgical resection of the affected bowel segment.

Prognosis

The prognosis of Ogilvie syndrome is generally good with appropriate treatment. However, if left untreated, it can lead to serious complications such as colonic perforation, peritonitis, and sepsis.

Related pages

• Colonic pseudo-obstruction
• Bowel obstruction
• Autonomic nervous system

External links

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