From the Research
Management of Ogilvie's Syndrome
The management of Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, can be divided into several approaches:
- Conservative management: This includes observation, rectal tube, nasogastric tube, fluid resuscitation, and correction of electrolytes 1
- Interventional management: This includes the use of acetylcholinesterase inhibitors such as neostigmine, decompressive procedures including colonoscopy, and surgery 1, 2, 3
- Pharmacological management: This includes the use of medications such as guanethidine and neostigmine to manipulate the autonomic innervation to the colon 4
Treatment Options
The treatment options for Ogilvie's syndrome depend on the severity of the condition and the presence of complications:
- Patients with perforation or suspected ischemia undergo operative intervention 3, 5
- Patients without complications undergo initial conservative management with bowel rest, correction of electrolyte disturbances, and mobilization 3
- Patients who fail conservative management or have prominent cecal dilatation undergo decompression with either neostigmine or colonoscopy 3
Key Considerations
The management of Ogilvie's syndrome requires careful consideration of the following factors:
- The underlying pathophysiology of the condition remains unclear 3
- The condition can progress to bowel ischemia and perforation with significant morbidity and mortality if left unresolved 5
- Conservative management may be sufficient in some cases, while interventional management may be necessary in others 1
- The use of narcotics can affect the management of the condition, and its relation to maximal bowel size should be analyzed 1