[Acute colonic pseudo-obstruction: Ogilvie syndrome]. / Akute Kolonpseudoobstruktion: Ogilvie-Syndrom.

Acute colonic pseudo-obstruction (ACPO) is characterized by marked colonic dilatation which develops over several days. ACPO is due to a motility disorder and is not caused by colonic obstruction and occurs in patients with severe, often acute underlying diseases or postoperatively. It is associated with a 25-30% mortality overall that increases to up to 50% in patients who develop complications (e.g. colonic ischemia and perforation). The pathogenesis of the disorder has not yet been clarified and clinical symptoms and signs are relatively unspecific. In particular, ACPO has to be differentiated from colonic obstruction and toxic megacolon. For this blood tests and radiological tests are required, e.g. plain abdominal radiograph, abdominal computed tomography (CT) and water soluble contrast enema, which are also required for detection of complications. Patients with ACPO should generally receive supportive therapy for decompression of the gastrointestinal tract (e.g. gastric and rectal tubes) and to minimize predisposing factors. In most uncomplicated cases this leads to resolution of colonic dilatation. Clinical and radiological controls at close intervals are required until the condition is resolved. If patients do not respond within 1-2 days or if ACPO has already reached a critical duration (>3-4 days) or extent (i.e. cecal diameter ≥12 cm), neostigmine should be administered and leads to durable success in approximately 3 out of 4 patients. Patients who are still refractory to treatment should receive endoscopic decompression. More invasive therapeutic options, such as cecostomy or (segmental) colonic resection should only be considered for patients who still do not respond to treatment or present with the abovementioned complications.

[Diagnosis and treatment of acute colonic pseudo-obstruction]. / Diagnostik og behandling af akut colonpseudoobstruktion.

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a clinical condition with acute dilatation of the colon without a provable mechanical cause. Early recognition and treatment of the condition is important in order to improve the outcome. The diagnosis is based on clinical and radiographic findings. Supportive therapy should be the initial management. If no improvement occurs after 24 hours, medical treatment with neostigmine administered i.v. is instituted and repeated if necessary. Colonoscopic decompression is the next step, but if ischaemia or perforation appear surgery should be performed.

A systematic review of medical diagnosis of Ogilvie's syndrome in childbearing.

OBJECTIVE: to review all published papers examining medical diagnosis of Ogilvie's syndrome and pregnancy with a view to assessing the implications of the diagnosis and the condition itself for childbearing women, midwives and medical practitioners. DESIGN: systematic review. SEARCH STRATEGY: MEDLINE, CINAHL, EMBASE, Web of Science and Cochrane databases were searched from 1950 to 2006 inclusive. Papers were read by two independent researchers and selected if they informed the link between Ogilvie's syndrome and childbearing or were concerned with other aspects of maternal mortality. FINDINGS: 23 papers fulfilled the selection criteria and were of a suitable standard. Inconsistencies in relation to the diagnosis of Ogilvie's syndrome were noted, and an increase in maternal deaths from this condition was reported up to 2002. KEY CONCLUSIONS: this paper highlights the strengths and weaknesses of medical diagnosis, as exemplified by Ogilvie's syndrome. The scientific basis of diagnoses such as Ogilvie's syndrome may deserve attention. This diagnosis has been shown to be unstable, both in temporal and aetiological terms. The midwifery and nursing reaction to the abrupt appearance of this condition is, at best, unfortunate. The attribution of blame to midwifery practices is deserving of a more robust response. IMPLICATIONS FOR PRACTICE: there may be clinical implications of the diagnosis of Ogilvie's syndrome for other aspects of maternity (including any nursing) care. A particularly significant area is the widely recognised increase in the caesarean rate with which Ogilvie's syndrome has been closely linked.

Colonic pseudo-obstruction.

Colonic pseudo-obstruction is often confused with mechanical intestinal obstruction. It occurs when there is an autonomic imbalance resulting in sympathetic over-activity affecting some part of the colon. The patient is often elderly with numerous comorbidities. Once mechanical obstruction is excluded by contrast enema, the patient should be treated conservatively with nasogastric and flatus tubes for at least 48 hours, and precipitating factors should be treated. When pseudo-obstruction does not settle with waitful watching, prokinetic agents and/or colonoscopic decompression can be tried. When there is a risk of impending perforation of the caecum from massive colonic dilatation and colonic ischaemia, it should be dealt with by caecostomy or hemicolectomy. In spite of available medical and surgical interventions, the outcome remains poor.

Treatment of pediatric Ogilvie's syndrome with low-dose erythromycin: a case report.

Acute colonic pseudo-obstruction is a poorly understood syndrome, characterized by the signs, symptoms and radiological pattern of a large bowel obstruction without evidence for a mechanical obstruction. We report a case of a 2-year old boy who presented with progressive abdominal distention, vomiting and abdominal pain on postoperative d 3. Plain abdominal z-ray showed markedly dilated large bowel. Mechanical colonic obstruction was ruled out with hypaque enema. Ogilvie's syndrome was suspected. The patient received treatment with oral erythromycin which had an immediate beneficial effect. During the 6 mo follow-up, no recurrences of symptoms were observed. We provide a safe and effective therapy for Ogilvie's syndrome in pediatric individuals.

Splenic flexure volvulus in a child with chronic idiopathic intestinal pseudo-obstruction syndrome.

Splenic flexure volvulus in a child with chronic idiopathic intestinal pseudo-obstruction syndrome is extremely rare. Here we present a case report of this unusual condition in a 7-year-old girl. The splenic flexure volvulus was managed by pressure reduction from the cecal antegrade continence enema, after which elective resection of the splenic flexure and primary anastomosis were performed because she had similar attacks during 4 months after the first detorsion. Postoperatively she made an uneventful recovery. Possible factors of pathogenesis and therapeutic measures are discussed.

[Ogilvie's syndrome: a rare cause of the acute abdomen]. / Das Ogilvie-Syndrom: eine seltene Ursache des akuten Abdomens.

Ogilvie's syndrome (acute colonic pseudo-obstruction) is a rare clinical disease characterized by segmental distension of the proximal colon caused by a paralysis without mechanic obstruction. It may be a sequel of underlying neurological, medical or surgical disease. Risk factors are respiratory decompensation, electrolyte disturbances and different drugs. A special kind is the primary idiopathic pseudoobstruction with a high risk of perforation or necrosis. Especially elderly patients (> 70 years) with cardiovascular or neurologic diseases and accordant drugs are concerned. Clinical symptoms are progressive abdominal distension and abdominal pain like an acute abdomen. The differential diagnosis of a mechanic ileus is important for further treatment. This case report should draw attention to this rare disease.

Isquemia colónica grave: factores pronósticos y tratamiento / Grave colonic ischemia: prognostic factors and treatment

Antecedentes: Si bien la isquemia intestinal aguda representa sólo el 0,9 por ciento de los casos hospitalizados por abdomen agudo, su alta morbimortalidad convierte a esta afección en un verdadero desafío para internistas y cirujanos. Objetivos: Evaluar en forma retrospectiva nuestra casuística, analizando los principales aspectos referidos al diagnóstico, los factores predisponentes con su eventual injerencia pronóstica y el tratamiento realizado. Material y métodos: Se presentan 22 casos de isquemia colónica aguda, operados en el Servicio de Cirugía General y Coloproctología de la Clínica Modelo de Lanús entre Enero de 1995 y Diciembre de 2000. Se analizaron los factores predisponentes y la extensión de la isquemia hallada en la cirugía, como posibles factores predictivos de mortalidad. Resultados: La edad promedio fue de 78 años con un rango entre 70 y 86. La causa de la isquemia fue en diecinueve de los 22 casos atribuida a hipoflujo y en tres ocasiones a la cirugía aórtica de urgencia. El hallazgo operatorio en 8 pacientes fue isquemia total del colon (36,4 por ciento) y en 14 segmentaria (63,6 por ciento). Sólo la extensión de la necrosis presentó tendencia a la significación estadística como factor predictivo de mortalidad (p=0.192). La morbilidad fue del 72.7 por ciento y la mortalidad alcanzó el 63.6 por ciento (14 casos) como consecuencia de falla múltiple de órganos y sistemas por sepsis no controlada. Conclusiones: Se puede afirmar que el advenimiento de métodos de estudio más complejos no ha modificado la evolución natural de las isquemias colónicas graves, disminuir su alta morbimortalidad aún depende del conocimiento y la sagacidad médica.

Isquemia colónica grave: factores pronósticos y tratamiento / Grave colonic ischemia: prognostic factors and treatment

Antecedentes: Si bien la isquemia intestinal aguda representa sólo el 0,9 por ciento de los casos hospitalizados por abdomen agudo, su alta morbimortalidad convierte a esta afección en un verdadero desafío para internistas y cirujanos. Objetivos: Evaluar en forma retrospectiva nuestra casuística, analizando los principales aspectos referidos al diagnóstico, los factores predisponentes con su eventual injerencia pronóstica y el tratamiento realizado. Material y métodos: Se presentan 22 casos de isquemia colónica aguda, operados en el Servicio de Cirugía General y Coloproctología de la Clínica Modelo de Lanús entre Enero de 1995 y Diciembre de 2000. Se analizaron los factores predisponentes y la extensión de la isquemia hallada en la cirugía, como posibles factores predictivos de mortalidad. Resultados: La edad promedio fue de 78 años con un rango entre 70 y 86. La causa de la isquemia fue en diecinueve de los 22 casos atribuida a hipoflujo y en tres ocasiones a la cirugía aórtica de urgencia. El hallazgo operatorio en 8 pacientes fue isquemia total del colon (36,4 por ciento) y en 14 segmentaria (63,6 por ciento). Sólo la extensión de la necrosis presentó tendencia a la significación estadística como factor predictivo de mortalidad (p=0.192). La morbilidad fue del 72.7 por ciento y la mortalidad alcanzó el 63.6 por ciento (14 casos) como consecuencia de falla múltiple de órganos y sistemas por sepsis no controlada. Conclusiones: Se puede afirmar que el advenimiento de métodos de estudio más complejos no ha modificado la evolución natural de las isquemias colónicas graves, disminuir su alta morbimortalidad aún depende del conocimiento y la sagacidad médica. (AU)

Ogilvie's syndrome (colonic pseudo-obstruction) occurring in an 18-year-old Nigerian female.

Ogilvie's syndrome which is colonic obstruction without an identifiable distal mechanical cause is reported in an 18 year old female Nigerian. A high index of awareness is required to diagnose this condition.

Síndrome de Ogilvie: relato de dois casos / Ogilvie syndrome: report of two cases

A pseudo-obstruçäo colônica aguda ou Síndrome de Ogilvie foi descrita primeiramente em 1948. Caracteriza-se por sinais e sintomas de obstruçäo colônica sem evidência de causa mecânica, geralmente ocorrendo em pacientes gravemenrte enfermos. A incidência é controversa devido ao näo reconhecimento desta patologia e ao fato de muitos casos apresentarem melhora espontânea. A etiologia näo está completamente elucidada devido às diferentes condiçöes clínicas que acompanham a síndrome. O diagnóstico baseia-se na apresentaçäo clínica, estudo radiológico e endoscópico. O tratamento consiste na descompressäo colônica, realizada na maioria dos casos com colonoscopia ou uso de neostigmia endovenosa. Raramente necessita de tratamento cirúrgico. Os autores relatam dois casos de Síndrome de Ogilvie, cujo diagnóstico foi clínico e radiológico. Ambos pacientes foram tratados com descompressäo colonoscópica e posicionamento de sonda retal, havendo remissäo do quadro clínico em apenas um dos casos. O outro paciente foi tratado com neostigmina endovenosa com melhora rápida e satisfatória do quadro clínico.

Informe de un enfermo con síndrome de Ogilvie / Ogilvie syndrome: report of a case

Informamos los hallazgos clínicos de un paciente con diagnóstico de síndrome de Ogilvie asociado a insuficiencia cardíaca y enfisema pulmonar, en el cual se descartó la posibilidad de volvulus de ciego mediante colon por enema y se dio tratamiento inicial con cisaprida, eritromicina y misoprostol sin tenerse buena respuesta, por lo que el tratamiento definitivo se realizó mediante descompresión colónica endoscópica e instalación de una sonda en el ciego, con lo cual se resolvió el cuadro clínico

Acute colonic pseudo-obstruction.

BACKGROUND: Acute colonic pseudo-obstruction is an acute non-mechanical colonic obstruction. Twenty patients with this condition presenting between 1988 and 1996 were retrospectively reviewed to identify the incidence and potential aetiologic factors, and to establish a uniform therapeutic approach. METHODS: Patients who fulfilled the criteria of acute pseudo-obstruction of the colon were reviewed retrospectively from a computerized database, and from a study of the hospital notes. RESULTS: There were 12 men and eight women with a median age of 71 years. Seventeen patients (85%) had various coexisting medical conditions, and none of the cases had a recent surgical operation or trauma. Four patients had previous similar attacks. Patients had a median duration of symptoms and a hospital stay of 3 and 7 days, respectively. Diagnosis was based on the clinical features coupled with the findings on plain abdominal X-rays and contrast enema. Sixteen patients were successfully treated conservatively over a median time of 5 days. Three patients had a laparotomy: two patients had tube caecostomy (followed by complications), and one patient had no further treatment. One patient had colonoscopy with an unsatisfactory result. Two patients (10%) died and three (15%) developed complications. CONCLUSIONS: Acute colonic pseudo-obstruction is an uncommon but serious condition. The majority of our patients (17/20) had associated significant medical problems. Most of the patients were successfully managed conservatively. This was the preferred initial line of treatment in this department during the study period.

Pseudobstrucción aguda de colon (síndrome de Ogilvie) / Acute colonic pseudo-obstruction (Ogilvie' syndrome)

Informe de tres casos y revisión de la literatura sobre el síndrome de pseudobstrucción aguda de colon. Este estudio presenta 3 casos, sexo femenino, entre 21 y 35 años, postcesarea, con signos y síntomas comunes con progresión a abdomen agudo oclusivo, entre 3 y 6 días de evolución. La condición de ausencia de causa obstructiva mecánica fue estudiada en 2 casos por colon por enema a baja presión. El tratamiento en 100 por ciento de los casos fue quirúrgico, encontrándose perforación cecal, (c1, c2, c3), de colon ascendente (c3) y de transverso (c3). La mortalidad fue del 33.33 por ciento (un caso). Se revisan los tratamientos descriptos en la literatura

Pseudobstrucción aguda de colon (síndrome de Ogilvie) / Acute colonic pseudo-obstruction (Ogilvie syndrome)

Informe de tres casos y revisión de la literatura sobre el síndrome de pseudobstrucción aguda de colon. Este estudio presenta 3 casos, sexo femenino, entre 21 y 35 años, postcesarea, con signos y síntomas comunes con progresión a abdomen agudo oclusivo, entre 3 y 6 días de evolución. La condición de ausencia de causa obstructiva mecánica fue estudiada en 2 casos por colon por enema a baja presión. El tratamiento en 100 por ciento de los casos fue quirúrgico, encontrándose perforación cecal, (c1, c2, c3), de colon ascendente (c3) y de transverso (c3). La mortalidad fue del 33.33 por ciento (un caso). Se revisan los tratamientos descriptos en la literatura

Pseudoobstruction of the colon: early recognition and therapy.

A case of pseudoobstruction of the colon in a patient receiving oral nimodipine therapy is presented. Early recognition of this entity, diagnostic aids, and therapy are discussed. Successful colonoscopic decompression and close observation allowed completion of nimodipine course of therapy.