Ogilvie Syndrome

• • Massive colonic distention in the absence of mechanical obstruction

  • Severe form of ileus

  • May result from autonomic imbalance

  • Aerophagia and impairment of colonic motility by drugs are contributing factors

  • Diagnosis of exclusion

  • -Must rule out mechanical obstruction

Epidemiology

• • Most common in bedridden, elderly patients; following orthopedic injuries; in patients taking psychotropic medications or narcotics

  • Associated with metabolic disorders:

  • -Hypothyroidism

    -Diabetes

    -Renal failure

  • Associated with collagen vascular diseases:

  • -Lupus

    -Amyloidosis

    -Scleroderma

Symptoms and Signs

• • Abdominal distention without pain or tenderness initially

  • Later symptoms may mimic obstruction: abdominal pain, tenderness

  • Tympanitic abdomen

  • Peritoneal signs indicate bowel compromise and/or perforation

  • Bowel sounds often diminished or absent

Laboratory Findings

• • May reveal electrolyte abnormalities (especially magnesium and potassium)

  • WBC count usually normal, but an elevation may indicate bowel compromise

Imaging Findings

• • Abdominal x-ray: Marked gaseous distention of colon, especially right colon

  • Contrast enema: Absence of mechanical obstruction

• • Mechanical obstruction

  • -Carcinoma

    -Hernia

    -Stricture

    -Adhesions

    -Diverticulitis

    -Volvulus

    -Intussusception

  • Hirschsprung disease

  • Toxic megacolon

  • Fecal impaction

Rule Out

• • Mechanical obstruction

• • Rule out mechanical obstruction

  • Review medication history

  • Obtain abdominal x-ray

  • Contrast enema to determine presence of mechanical obstruction

When to Admit

• • Must rule out other etiologies for bowel obstruction and perform serial exams

• • NG decompression and aggressive enema regimen: Resolution in 86% of patients

  • Bowel rest

  • Rectal tube placement

  • Correct metabolic abnormalities

  • Discontinue medications that decrease motility

  • Colonoscopic decompression if cecum dilated > 9-10 cm

  • If performing colonoscopy, use minimal to no air insufflation

  • May place long decompression tube at colonoscopy (Miller or Cantor tube)

  • Ensure adequate volume status

  • Remove or drain septic collections/abscesses

Surgery

Indications

• • Failure to reduce dilation following conservative measures and endoscopic intervention

  • Laparotomy should be performed in patients with peritonitis, nonviable bowel

  • Perforated cecum may require ileocecectomy, end ileostomy, and mucus fistula

  • Nonperforated cecum may be managed with tube cecostomy

Contraindications

• • Ogilvie syndrome occurs most frequently in patients with severe medical comorbidities; early recognition is essential to decrease the need for surgical therapy for complications (perforation/peritonitis)

Medications

• • Neostigmine (anticholinesterase) may be efficacious in decompressing colon (must be used in monitored setting)

Treatment Monitoring

• • Serial abdominal exam

  • Serial abdominal x-rays following colonoscopic decompression

Complications

• • Bowel ischemia/necrosis

  • Perforation/peritonitis/sepsis

Prognosis

• • Most cases resolve with ...