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Colonic Pseudo- o bstruction (Ogilvie Syndrome)


Introduction

Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is a nonmechanical, functional obstruction of the large intestine. It has become a well-known clinical entity, but in many regards it is poorly understand and difficult to manage. In 1948 a British surgeon, Sir Heneage Ogilvie, first described acute colonic pseudo-obstruction in two patients who had colonic dilatation without an obvious mechanical cause. Both patients had extensive invasion and destruction of the celiac plexus associated with retroperitoneal malignancy. Ogilvie hypothesized that this neural involvement produced a functional obstruction. Today, acute colonic pseudo-obstruction is a differential diagnosis for hospitalized patients who have abdominal distention. Diagnosis without undue delay is crucial because of the need to exclude a mechanical obstruction and the risk of colonic perforation. Conservative measures often lead to resolution. When medical therapy fails or is contraindicated, endoscopy can be effective in achieving decompression, and surgery is the last resort. New advanced techniques in endoscopy, such as the use of decompression tubes and percutaneous endoscopic cecostomy, have decreased the need for resection.

Epidemiology

The incidence of Ogilvie syndrome is unknown, but most studies indicate that elderly patients are at greatest risk. In a review by Vanek et al of 400 cases, a list of associated conditions was compiled, which included obstetric, gynecologic, or pelvic surgery (19%); trauma/orthopedic procedures (18%); infection (10%); cardiac events (10%); and neurologic events (9%). Other conditions connected with acute pseudo-obstruction of the colon included electrolyte imbalances, certain medications, organ transplant, connective tissue disorders, and debilitated states ( Box 53-1 ).

BOX 53-1
Underlying Conditions Associated with Ogilvie Syndrome

Cardiovascular

  • Myocardial infarction

  • Congestive heart failure

  • Peripheral vascular disease

  • Cardiovascular surgery

  • Aortic aneurysm

Pulmonary

  • Pneumonia

  • Mechanical ventilation

  • Pulmonary embolus

  • Chronic obstructive pulmonary disease

  • Thoracic surgery

Neurologic

  • Cerebrovascular accident

  • Nerve root compression

  • Multiple sclerosis

  • Subarachnoid hemorrhage

  • Parkinson disease

  • Dementia

Trauma

  • Abdominal trauma

  • Pelvic fracture

  • Spinal trauma

  • Femoral fracture

  • Burns

Surgery

  • Abdominal surgery

  • Pelvic/gynecologic surgery

  • Cardiovascular surgery

  • Thoracic surgery

  • Hip surgery

  • Craniotomy

  • Spinal surgery

  • Cesarean section

  • Renal transplantation

  • Liver transplantation

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