Acute colonic pseudo-obstruction in polytrauma patients.

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aimed to explore risk factors and clinical outcomes of ACPO in polytrauma patients and contribute information to the limited literature on this condition. METHODS: This retrospective study, conducted at a Level 1 trauma center, analyzed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was used. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors. RESULTS: There were 57 cases of ACPO, with an incidence of 1.7 per 1,000 patients, rising to 4.86 in major trauma. Predominantly affecting those older than 50 years (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPBs) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and shock index >0.9, Injury Severity Score >18, opioid use, RPBs, and pelvic fractures. A cecal diameter of ≥12 cm had a significant association with cecal ischemia or perforation. CONCLUSION: This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPBs, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favorable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

Risk factors for acute colonic pseudo-obstruction after caesarean section: A retrospective case-control study.

BACKGROUND: Pregnancy and caesarean section are known to predispose to the development of acute colonic pseudo-obstruction (ACPO), a rare form of functional ileus of the distal large bowel. Pathogenesis of ACPO is likely influenced by pregnancy and childbirth and subsequent changes to hormonal, autonomic and metabolic physiology. Identifying pregnancy risk factors will assist with early identification, as the insidious onset postpartum often leads to delayed diagnosis and bowel ischaemia, perforation and sepsis. AIMS: To establish pregnancy risk factors associated with the development of ACPO after caesarean section. MATERIALS AND METHODS: A retrospective case-control study included 19 121 women undergoing caesarean between 1 January 2008 and 31 December 2016 at a tertiary referral hospital. Twenty-three cases of computerised tomography (CT)-diagnosed ACPO post-caesarean were identified from hospital medical records and imaging databases. Controls were matched for gestational and maternal age within one week of delivery with a ratio of 1:3. RESULTS: The incidence of ACPO was one in 800 caesarean sections. ACPO was significantly more likely to occur in women who had been administered opioid analgesia in labour (odds ratio (OR) 4.67, P = 0.04), and a trend for increased estimated blood loss (OR 1.01, P = 0.01). There was no increased risk associated with emergency or elective caesarean classification, previous abdominal surgery, type of anaesthesia, duration of labour, oxytocin augmentation, intrapartum fever, hypertensive disorders, diabetes in pregnancy, antepartum haemorrhage, multiple gestation, fetal presentation or birthweight. CONCLUSIONS: Risk factors for developing ACPO post-caesarean include opioid analgesia in labour and a trend for increased blood loss.

Incidence and Risk Factors for the Development of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) in Total Joint Arthroplasty Patients.

BACKGROUND: Acute colonic pseudo-obstruction (Ogilvie syndrome [OS]) is a rare but devastating condition that can develop in orthopaedic patients postoperatively. The objective of this study was to identify the risk factors for developing OS after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to compare the outcomes between patients who did and did not develop OS postoperatively. METHODS: This was a retrospective review using the National Inpatient Sample, a national database incorporating inpatient hospitalization information. ICD-9 codes were used to identify patients who underwent primary and revision THA or TKA. Patients were separated based on the diagnosis of OS. Primary outcomes assessed included patient mortality, postoperative complications, length of stay, and cost during index hospitalization. RESULTS: From 2001 to 2014, a total of 12,541,169 patients underwent primary and revision THA or TKA. Of those, 3,182 patients (0.03%) developed OS postoperatively. There was an increased incidence of OS in revision THA and TKA compared with primary THA and TKA. Fluid and electrolyte disorders were associated with the largest increased adjusted risk of OS. Patients with OS had an increased adjusted risk of overall postoperative complications and being discharged to skilled nursing facility. Patients with OS had an increased average length of stay and hospitalization cost compared with patients without OS. DISCUSSION: Given our findings, the risk factors for the development of OS, including revision surgery, should be identified and minimized during the perioperative period to prevent the development of this morbid and potentially life-threatening complication. LEVEL OF EVIDENCE: III (Retrospective cohort study).

Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆.

OBJECTIVE: To investigate whether women who developed acute colonic pseudo-obstruction (ACPO) after cesarean section have a higher degree of gastro-intestinal symptoms than women who did not develop ACPO after cesarean section. ACPO is a colonic dilatation without mechanical obstruction, and with an unknown pathophysiology. In younger people it is mostly seen in women after cesarean section. The hypothesis of the present study is that long-term consequences of gastrointestinal symptoms evolve after ACPO, due to the impact on the colon. STUDY DESIGN: 40 women who developed ACPO after cesarean section (cases) and 80 women, who did not develop ACPO after cesarean section (controls), were asked to participate in the study. The controls were matched based on time of cesarean section (± 14 days), age (±5 years), singleton or twin, parity, cesarean section grade, and ASA-group. Baseline characteristics and information regarding the cesarean section were collected from medical records. An electronic collection of surveys was distributed to the participants, including the following: Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS), Rome IV, Gastrointestinal Symptoms Rating Scale (GSRS), Visceral Sensitivity Index (VSI), Patient Health Questionnaire 15 (PHQ15), The MOS 36-item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The score from IBS-SSS after cesarean section was used as the primary outcome. RESULTS: 25 cases and 37 controls participated in the study. A difference in blood loss was found with a median of 600 mL in cases, compared to 400 mL in controls during cesarean section (p = 0.002). No difference was found between cases and controls in the IBS-SSS score after cesarean section. However, cases yielded a higher difference between IBS-SSS before and after cesarean section, indicating a higher degree of deterioration in gastrointestinal symptoms (p = 0.026). In addition, cases reported a higher degree of pain in everyday life (p = 0.039). No difference was found in the remaining surveys. CONCLUSION: Women undergoing cesarean section developed mild grade of irritable bowel syndrome. However, gastrointestinal symptoms did not seem to be more prevalent in women who developed ACPO, although women with ACPO had a higher degree of deterioration in gastrointestinal symptoms than controls.

Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms.

AIM: To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODS: A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTS: No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSION: Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.

Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature.

BACKGROUND: Colonic pseudo-obstruction (CPO) is characterized by colonic distention in the absence of mechanical obstruction or toxic megacolon. Concomitant secretory diarrhea (SD) with hypokalemia (SD-CPO) due to gastrointestinal (GI) loss requires further characterization. AIM: To perform a systematic review of SD-CPO, report a case study, and compare SD-CPO with classical CPO (C-CPO). METHODS: We performed a search of MEDLINE, EMBASE, Cochrane, and Scopus for reports based on a priori criteria for CPO, SD and GI loss of potassium. An additional case at Mayo Clinic was included. RESULTS: Nine publications met inclusion criteria, with a total of 14 cases. Six studies had high, three moderate, and our case high methodological quality. Median age was 74 years (66-97), with 2:1 male/female ratio. Kidney disease was present in 6/14 patients. Diarrhea was described as profuse, watery, or viscous in 10 patients. Median serum, stool, and urine potassium concentrations (mmol/L) were 2.4 (range: 1.9-3.1), 137 (100-180), and 17 (8-40), respectively. Maximal diameter of colon and cecum (median) were 10.2 cm and 10.5 cm, respectively. Conservative therapy alone was effective in five out of 14 patients. Median potassium supplementation was 124 mEq/d (40-300). Colonic decompression was effective in three out of six patients; one had a total colectomy; three out of 14 had died. The main differences between SD-CPO and C-CPO were lower responses to treatments: conservative measures (35.7% vs 73.6%, P=.01), neostigmine (17% vs 89.2%, P<.001), and colonic decompression (50% vs 82.4%, P=.02). CONCLUSION: SD-CPO is a rare phenotype associated with increased fecal potassium and is more difficult to treat than C-CPO.

Postpartum Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome): A systematic review of case reports and case series.

INTRODUCTION: Ogilvie's Syndrome or Acute Colonic Pseudo-Obstruction (ACPO) is a rare condition characterized by massive dilatation of the colon in the absence of mechanical obstruction. About 10% of all reported cases are related to Obstetric and Gynaecological procedures, Caesarean section being the commonest associated factor. Acute intestinal dilatation, if not treated, may lead to perforation and faecal peritonitis with consequent high morbidity and mortality. MATERIALS AND METHODS: An electronic literature searches were performed in PubMed, EMBASE, Google scholar and hand searches for relevant references were included without any language restriction. All the records reported after year 2002 were included for the full review. We analyzed the quality of the reports and the data was further analyzed for their respective risk factors, clinical features, management methods, morbidity and mortality. RESULTS: The results from our searches included a total of 125 cases of postpartum ACPO. A total of 66 cases were reported in 37 publications after year 2002. Details of delivery were recorded in 13(19%), clinical manifestations in 49(69%), imaging results in 43(65%) and management described in 100% of the cases. Although 62(92%) cases were following caesarean section, no specific antepartum or intrapartum factors were associated with ACPO. The caesarean sections performed for indications of preeclampsia, multiple pregnancy, antepartum haemorrhage/placenta previa were more in this group of patients who developed ACPO compared to caesarean sections performed for same indication in general population of England and Wales. Abdominal distension and pain were the commonest symptoms, followed by vomiting. Fever was common in patients with perforation. Twenty eight (43%) patients had intestinal perforation or impending perforation, and 31(47%) patients required laparotomy. Conservative management was successful in 33(50%) patients. All patients with a caecal diameter of more than 12cm perforated compared to 3/17 with a diameter of less than 9cm. Most perforations were diagnosed between postoperative day 3 and day 5. Only one case of mortality has been recorded (1.5%). CONCLUSIONS: No specific risk factors could be identified for postpartum ACPO. A postpartum patient with abdominal distension and pain should have appropriate imaging to rule out colonic dilatation and/or perforation. Perforation may occur with a caecal diameter of less than 9cm but it is more likely if the diameter exceeded 12cm. The mortality risk appears to be low in the postpartum group compared to other patients with ACPO. There is a need for establishing national level databases to capture all the relevant data in a consistent manner, to understand this rare disease process.

The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients.

BACKGROUND: Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies. METHODS: Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded. RESULTS: Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy. CONCLUSION: Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair.

Acute Colonic Pseudo-obstruction: Defining the Epidemiology, Treatment, and Adverse Outcomes of Ogilvie's Syndrome.

Acute colonic pseudo-obstruction (ACPO) is a rare but often fatal disease. Herein, we present the largest study to date on ACPO. The National Inpatient Sample was queried for ACPO diagnoses from 1998 to 2011. Patients were analyzed by treatment into four groups: medical management (MM), colonoscopy alone [(endoscopy-only group) ENDO], surgery alone (SURG), or surgery and colonoscopy (SAC). Logistic regression was used to identify predictors of adverse outcomes by treatment group. There were 106,784 cases of ACPO: 96,657 (90.5%) MM, 2,915 (2.7%) ENDO, 6,731 (6.3%) SURG, and 481 (0.5%) SAC. The medical complication (45.7%), procedural complication (15.9%), and mortality rates (7.7%) were high. Increasing procedure invasiveness was independently associated with higher odds of medical complications, procedural complications, and death (P < 0.0125). The odds of death were significantly higher in the ENDO [odds ratio (OR) = 1.2], SURG (OR 1.4), and SAC (OR = 1.8) groups (P < 0.0125). Those who fail MM and require procedures have increasing morbidity and mortality with increasing invasiveness, likely reflecting the severity of their conditions.

[The Ogilvie syndrome in elderly patients with multimorbidity]. / Het Ogilvie-syndroom bij oudere patiënten met multiproblematiek.

Two patients presented with the Ogilvie syndrome which is an acute colonic pseudo-obstruction without any mechanical obstruction. Both patients suffered from multiple medical conditions such as infections, electrolyte disturbances and functional decline.The Ogilvie syndrome is particularly seen in patients with multimorbidity who stay in the hospital or nursing home. The incidence of the Ogilvie syndrome will probably increase because of ageing of our population and will be most prevalent in the frail elderly. The precise mechanism of this disease is still unclear, but there is evidence in the literature that the aetiology is multifactorial and runs via autonomic dysregulation of the colon.Early recognition and appropriate treatment may reduce the risk of complications and limit mortality, also depending on the related comorbidity.

[Treatment of acute colonic pseudo-obstruction (Ogilvie's Syndrome). Systematic review]. / Traitement dela Pseudo-Obstruction Colique Aigue (Syndrome d'Ogilvie) Revue Systématique de la Littérature.

BACKGROUND: Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. AIMS: Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. METHODS: An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. RESULTS: Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose (evidence level 2, grade recommendation B). Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt , a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% (level evidence 4, recommendation grade C). PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression (evidence level 2, recommendation grade B). The cecostomy is more effective and safer than conventional colostomy (level of evidence 4, recommendation grade C). The cecostomy is highly effective in colonic decompression but associated with a high mortality (level of evidence 4, recommendation grade C). CONCLUSION: Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression.

[Case-control study on acute colonic pseudo-obstruction after total hip or knee arthroplasty].

OBJECTIVE: To investigate the incidence, predisposing factors and therapeutic modalities of acute colonic pseudo-obstruction (ACPO) in patients after total hip arthroplasties (THA) and total knee arthroplasties (TKA). METHODS: From January 2006 to December 2009, 12 patients with ACPO after THA and TKA operation were investigated retrospectively,who were viewed as the ACPO group. There were 10 males and 2 females with an average age of (78 +/- 12) years in the ACPO group. Other 853 patients without ACPO after THA and TKA operation were viewed as the control group treated at the same period. The incidence of ACPO was calculated. The clinical data were collected and compared between the two groups including patient age, gender, procedure, anesthetic class, clinical presentation, radiographic findings, duration from index surgery to diagnosis of ACPO, treatment, postoperative mobilization time, and length of hospital stay. RESULTS: The incidence of ACPO was 1.4%. The incidence of primary THA (1.3%) was higher than that of primary TKA (0.4%); the incidence of hip and knee revisions (5.0%) was higher than that of primary THA and TKA (1.0%); there was no difference in incidence between hip revisions (5.5%) and knee revisions (4.0%). The mean age was (78 +/- 12) years old in ACPO group and (71 +/- 13) in the control group. The male/female ratio was 5:1 in ACPO group and 2:3 in control group. There were statistical differences in mean age and gender ratio between the two groups. No association was found with respect to anesthetic class. On average, ACPO occurred at 2.5 days after index surgery. The abdominal distention occurred in all 12 cases, nausea or vomiting in 8 cases and abdominal pain in 3 cases. Radiographically cecal dilation occurred in all cases and intestinal dilation in 3 cases. All patients initially were treated conservatively with immediate cessation of oral intake,a nasogastric tube and oral mineral oil. Three patients received a rectal tube. Only 1 patient required endoscopic decompression. There were no deaths after ACPO in the series. Mean mobilization time after surgery averaged (5.0 +/- 2.2) days in ACPO group compared with (2.5 +/- 1.1) days in the control group. Mean hospital stay averaged (16.5 +/- 6.4) days in ACPO group compared with (10.5 +/- 4.5) days in the control group. There were statistical differences in mean mobilization time after surgery and mean hospital stay between two groups. CONCLUSION: ACPO mainly happened in old male patients. The majority cases response to conservative treatment and their prognoses are good. But ACPO will delay mobilization time after surgery and increase hospital stay.

Ogilvie syndrome and herpes zoster: case report and review of the literature.

BACKGROUND: The very unusual association between herpes zoster and Ogilvie syndrome has received scant attention in the published literature. OBJECTIVES: This review discusses the published experience since 1950 and attempts to increase clinical awareness about the co-existence of both conditions. CASE REPORT: An 84-year-old male patient affected by herpes zoster presented with advanced acute colonic pseudo-obstruction and was successfully treated with colonic diversion. DISCUSSION: Twenty published studies (1950-2008) of 28 patients in whom the two conditions co-existed are reviewed. The review included 22 male and 7 female patients (24%) aged 32-87 years (mean, 61 years). Significant co-morbidities were present in 45% of the patients. The majority of patients were observed and treated conservatively (83%). Two patients died (7%), both suffering from respiratory complications and malignancy. CONCLUSION: Recognition of the combined syndrome may help to avoid unnecessary surgery. Laparotomy should be reserved as a last resort for when the obstruction cannot be successfully managed by endoscopy. A diverting colostomy can be used to monitor the blood supply and thus provide early warning for an impending abdominal catastrophe.

Acute colonic pseudo-obstruction in vascular patients (Ogilvie syndrome).

Two patients with acute colonic pseudo-obstruction are presented. Acute colonic pseudo-obstruction, first described by Ogilvie in 1948, is characterised by signs of colonic obstruction, but without mechanical obstruction to the intestinal flow. The current hypothesis states that it is caused by an imbalance between sacral parasympathetic excitatory nerves and sympathetic inhibitory nerves, thus inducing functional obstruction. It mostly develops in hospitalised patients with a variety of medical and surgical conditions. Two such patients with extensive co-morbidities, developed progressive colon dilatation with signs of acute peritonitis, and were operated on urgently. In both patients, right hemicolectomy and postoperative medical treatment resulted in complete recovery.

Surgery for acute abdominal conditions in intellectually-disabled adults.

BACKGROUND: Intellectually-disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually-disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed. METHODS: A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually-disabled adults operated for acute abdominal conditions over a 5-year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality. RESULTS: Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo-obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively. CONCLUSION: Intellectually-disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.

Acute colonic pseudo-obstruction (Ogilvie syndrome) after arthroplasty in the lower extremity.

BACKGROUND: Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is an uncommon postoperative complication of total hip and total knee arthroplasty that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality. METHODS: We conducted a retrospective case-control study of 1170 total hip and knee arthroplasties performed by one surgeon from 1995 to 2002, and identified eighteen patients with Ogilvie syndrome. Radiographs and medical records were analyzed for risk factors and treatment effectiveness. RESULTS: Eleven (1.6%) of 708 patients who had a total hip arthroplasty and seven (1.5%) of 462 patients who had a total knee arthroplasty had Ogilvie syndrome develop postoperatively. Seventeen of these patients had preoperative conditions and/or had received medications identified as risk factors for Ogilvie syndrome. The use of patient-controlled analgesia was associated with an earlier development of symptoms. Colonic decompression was performed in seven patients and was associated with a significantly shorter hospital stay (p = 0.019). CONCLUSIONS: Acute colonic pseudo-obstruction was equally prevalent after total hip and total knee arthroplasties. Most patients who had Ogilvie syndrome had risk factors that could be identified preoperatively. Knowledge of these risk factors can enable the physician to anticipate which patients may have Ogilvie syndrome develop and, therefore, to be vigilant for its development and judicious in the use of patient-controlled analgesia. We also found that decompressive colonoscopy reduced the risk of perforation and decreased the length of hospitalization for the patients in whom Ogilvie syndrome developed.

Acute colonic pseudo-obstruction following major orthopaedic surgery.

OBJECTIVE: Acute colonic pseudo-obstruction (ACPO) has been linked with multiple aetiologies including orthopaedic surgery. However, the actual incidence and natural progression are not well described in these patients. We aim to assess the incidence of ACPO in patients undergoing elective orthopaedic procedures, and to examine for potential exacerbating factors. PATIENTS AND METHODS: All patients from the orthopaedic directorate that had abdominal imaging in the five years from August 1998 to August 2003 were identified from radiology archives. A manual search of the patients' notes was conducted with data recorded on the patients' history, operative details and their postoperative course including their haematological and biochemical results. Details regarding their ACPO were documented with respect to the onset of symptoms, how the diagnosis was achieved, what treatment was instigated and how the condition progressed. A control group of age and sex matched patients was included for comparison. RESULTS: Thirty-five patients with ACPO were identified. The operations included 21 hip replacements, 10 knee replacements and 4 spinal operations. The incidence of ACPO was 1.3%, 0.65% and 1.19%, respectively. In comparison to control patients, patients with ACPO had a lower postoperative serum sodium (P = 0.001), a higher serum urea (P = 0.021) and remained in hospital longer (P < 0.001). CONCLUSION: ACPO is uncommon in orthopaedic patients, however, its occurrence results in prolonged hospital stay. Attention to patients' postoperative fluid balance and biochemical status may reduce the incidence.

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.