From the Guidelines
Pseudo bowel obstruction, or Ogilvie syndrome, typically presents with symptoms of progressive abdominal distention, abdominal pain, nausea, vomiting, and decreased or absent bowel movements, which can be life-threatening if not promptly recognized and treated. The symptoms of pseudo bowel obstruction can be severe and develop over hours to days, and patients often experience diffuse and cramping abdominal pain.
- Key symptoms include:
- Abdominal distention
- Abdominal pain
- Nausea and vomiting
- Decreased or absent bowel movements
- Constipation or diarrhea
- Physical examination findings may include a tympanic abdomen and diminished or high-pitched bowel sounds, as noted in various studies on bowel obstruction, including small bowel obstruction 1. The underlying mechanism of Ogilvie syndrome involves dysfunction of the autonomic nervous system controlling colonic motility, often triggered by medications, electrolyte imbalances, or systemic illness that disrupts normal gut nerve function.
- High-risk populations for Ogilvie syndrome include hospitalized patients with serious medical conditions, the elderly, and those who have recently undergone surgery, highlighting the need for prompt recognition and treatment to prevent complications such as perforation, particularly when the cecal diameter exceeds 12 cm.
From the Research
Symptoms of Pseudo Bowel Obstruction (Ogilvie Syndrome)
The symptoms of pseudo bowel obstruction, also known as Ogilvie syndrome, include:
- Abdominal pain
- Bloating
- Nausea
- Vomiting
- Inability to pass gas or stool 2
- Abdominal distension 3, 4
- Obstipation (severe constipation) 2
Clinical Presentation
The clinical presentation of Ogilvie syndrome can vary, but it is often characterized by:
- Acute onset of symptoms
- Significant colon distention without mechanical obstruction
- Radiological evidence of colonic dilation ≥9 cm 3
- Metabolic encephalopathy from hypokalemia and dehydration in some cases 2
Diagnosis and Treatment
Diagnosis of Ogilvie syndrome is based on clinical and radiologic grounds, and treatment can be conservative or interventional, including:
- Conservative management: observation, rectal tube, nasogastric tube, fluid resuscitation, and correction of electrolytes 3
- Pharmacological treatment: neostigmine, a cholinesterase inhibitor, which can lead to quick decompression in a significant proportion of patients 5, 6
- Endoscopic interventions: colonoscopy decompression 2, 4
- Surgical intervention: may be necessary in severe cases to relieve symptoms and prevent complications 4