From the Guidelines
Ogilvie syndrome after cesarean delivery should be managed with conservative measures, including bowel rest, nasogastric tube decompression, correction of electrolyte abnormalities, and discontinuation of medications that slow gut motility, as recommended by the Enhanced Recovery After Surgery (ERAS) society guidelines 1. The management of Ogilvie syndrome, or acute colonic pseudo-obstruction, after cesarean delivery is crucial to prevent serious complications. Key elements of postoperative care, as outlined in the ERAS guidelines 1, include early mobilization, urinary drainage, and discharge counseling, which can help reduce the risk of developing Ogilvie syndrome.
- Conservative measures should be initiated promptly, including:
- Bowel rest
- Nasogastric tube decompression
- Correction of electrolyte abnormalities
- Discontinuation of medications that slow gut motility If no improvement occurs within 24-48 hours or if the cecal diameter exceeds 12 cm, neostigmine should be administered at 2 mg IV over 3-5 minutes with cardiac monitoring, as it stimulates colonic motility by inhibiting acetylcholinesterase 1.
- Contraindications for neostigmine include:
- Bradycardia
- Asthma
- Recent myocardial infarction If neostigmine fails or is contraindicated, colonoscopic decompression should be considered, and surgery is reserved for cases with signs of peritonitis, perforation, or failure of all other interventions. Early recognition and prompt treatment are essential to prevent serious complications like bowel perforation, and the ERAS guidelines provide a framework for postoperative care that can help reduce the risk of Ogilvie syndrome 1.
From the Research
Colonic Pseudo-Obstruction (Ogilvie Syndrome) after Cesarean
- Colonic pseudo-obstruction, also known as Ogilvie syndrome, is a rare complication that can occur after cesarean section 2, 3.
- The condition is characterized by a disruption of normal colonic motility, leading to excessive gas and fluid accumulation in the colon 4.
- Diagnosis of Ogilvie syndrome can be challenging, but abdominal X-ray and water-soluble contrast enema are commonly used diagnostic modalities 2.
- Treatment options for Ogilvie syndrome include conservative management with bowel rest and decompression, as well as medications to enhance colonic motility 4, 5.
- In severe cases, endoscopic or surgical intervention may be necessary to relieve symptoms and prevent complications such as bowel ischemia or perforation 2, 3.
Risk Factors and Outcomes
- Pregnancy appears to be a predisposing factor for Ogilvie syndrome, and the condition can have a high morbidity rate 3.
- A systematic review of the literature found that conservative treatment was a successful first-line approach in 37% of cases, while laparotomy with decompression or colon resection was required in 34% of cases 3.
- Adverse events, including bowel ischemia and perforation, can occur in up to 66% of cases, and mortality rates can range from 5-10% 3, 5.
Treatment Strategies
- Neostigmine and decompressive colonoscopy are two efficacious treatment modalities for acute colonic pseudo-obstruction, with similar outcomes 5.
- Subcutaneous neostigmine has been shown to be safe and effective for the treatment of Ogilvie syndrome, with a success rate of 93% in one study 6.
- Early intervention with neostigmine and/or colonoscopy may not be associated with improved outcomes, and a colonoscopy-first approach may be associated with fewer subsequent interventions 5.