Acute colonic pseudo-obstruction or Ogilvie's syndrome. Report of two cases treated with colonoscopic decompression and review of the literature.

Acute colonic pseudo-obstruction (ACP), or Ogilvie's syndrome, is a disorder characterized by massive dilatation of the colon, and typically occurs in the critically ill or post-operative patient. The clinical presentation may be impossible to distinguish from mechanical causes of colonic obstruction. Its importance is reflected in an overall mortality of up to 30%, perforation of the cecum occurring in 14.8% of patients with a reported mortality of up to 46%. Medical therapy has had variable results. Tube cecostomy or other operative interventions can lead to much morbidity and mortality in the critically ill patient. Colonoscopy recently has proven to be highly effective in achieving colonic decompression as well as excluding a mechanical etiology for obstruction and poses minimal risk to the patient. Colonoscopy should be reserved for patients who show progressive cecal dilatation or who deteriorate clinically despite aggressive medical therapy. We report two patients with ACP treated with colonoscopy and review the literature.

Intramural gastrointestinal hemorrhage.

Intramural gastrointestinal hemorrhage should be suspected in patients taking anticoagulants who develop acute abdominal symptoms with clotting parameters out of the therapeutic range. Likewise, patients with inherent bleeding disorders may present with intramural hemorrhage. Characteristic features are seen on radiological examination; ultrasonography or computed tomography may be valuable noninvasive diagnostic approaches. The diagnosis may be supported by abdominal paracentesis. Surgical intervention is not necessary as conservative treatment, with replacement of clotting factors leading to rapid recovery.