What is Ogilvie syndrome?

From the Guidelines

Ogilvie syndrome is a condition characterized by acute colonic pseudo-obstruction, where the colon becomes severely dilated without any mechanical blockage, and its management involves conservative measures, medical therapy with neostigmine, and colonoscopic decompression, with surgery reserved for complications like perforation. The syndrome typically affects hospitalized patients who are critically ill, have undergone recent surgery, or have serious medical conditions, and causes symptoms similar to intestinal obstruction, including abdominal distension, pain, nausea, vomiting, and inability to pass gas or stool. Initial management involves conservative measures such as bowel rest, discontinuation of medications that slow gut motility, correction of electrolyte imbalances, and nasogastric tube decompression 1. If these fail, neostigmine (typically 2-2.5 mg administered intravenously over 3-5 minutes) may be given to stimulate colonic motility, though patients should be monitored for bradycardia during administration 1. For cases resistant to medical therapy, colonoscopic decompression may be necessary, and surgery is reserved for patients with complications like perforation or those who don't respond to other treatments 1. The condition occurs due to an imbalance in autonomic nervous system regulation of the colon, with decreased parasympathetic stimulation leading to colonic atony, and prompt recognition and treatment are essential as untreated cases can lead to serious complications including bowel perforation. Some key points to consider in the management of Ogilvie syndrome include:

• The importance of early recognition and treatment to prevent complications
• The use of conservative measures and medical therapy as first-line treatment
• The role of colonoscopic decompression in cases resistant to medical therapy
• The need for surgery in cases with complications like perforation
• The importance of monitoring for bradycardia during neostigmine administration
• The use of nasogastric tube decompression and bowel rest as part of conservative management. Overall, the management of Ogilvie syndrome requires a multidisciplinary approach and careful consideration of the patient's underlying medical conditions and potential complications.

From the Research

Definition of Ogilvie Syndrome

• Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a condition characterized by the dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction 2.
• It often occurs in debilitated patients and its pathophysiology is still poorly understood 2.

Clinical Presentation and Diagnosis

• The diagnosis of Ogilvie's syndrome is based on clinical and radiologic grounds, and can be treated conservatively or with interventions such as acetylcholinesterase inhibitors (such as neostigmine), decompressive procedures including colonoscopy, and even surgery 3.
• Computed tomography (CT) often reveals a sharp transition or "cut-off" between dilated and non-dilated bowel, and the possibility of organic colonic obstruction must be excluded 2.

Treatment Options

• Initial treatment should be conservative or pharmacologic using neostigmine; decompression of colonic gas is also a favored treatment in the decision tree, especially when cecal dilatation reaches dimensions that are considered at high risk for perforation 2.
• Alternative therapeutic methods include: epidural anesthesia, needle decompression guided either radiologically or colonoscopically, or percutaneous cecostomy 2.
• Surgery should be considered only as a final option if medical treatments fail or if colonic perforation is suspected; surgery may consist of cecostomy or manually-guided transanal pan-colorectal tube decompression at open laparotomy 2.
• Conservative management has been shown to yield similar, if not superior, results to interventional management in some studies 3.

Complications and Outcomes

• Ogilvie's syndrome is associated with a low inpatient mortality, but interventional management is often associated with a higher rate of complications 3.
• The use of narcotics in relation to maximal bowel size has also been analyzed, and it was found that there was no significant difference in bowel dilation, comorbidities, or narcotic use between the conservative and interventional management groups 3.
• Recurrence can be prevented by the use of a multiperforated Faucher rectal tube and oral or colonic administration of polyethylene glycol (PEG) laxative 2.