Ogilvie's Syndrome in a 66-Year-Old Man after Diaphragmatic Plication Surgery: A Rare Postoperative Complication.

BACKGROUND Mechanical and functional intestinal obstruction are serious postoperative complications. Acute colonic pseudo-obstruction (Ogilvie's syndrome) is an acute functional obstruction of the large intestine with various causes, including electrolyte disturbances, certain drugs, trauma, hypothyroidism, and, less often, certain procedures, such as abdominal, pelvic, orthopedic, cardiac, and, rarely, thoracic surgeries. It presents with abdominal distension without evidence of mechanical obstruction. This report is of a 66-year-old man with postoperative Ogilvie's syndrome 1 day after diaphragmatic plication surgery CASE REPORT We present a case of a 66-year-old man with no pre-existing chronic diseases who underwent diaphragmatic plication surgery performed to treat symptomatic diaphragmatic eventration, which was associated with chronic colonic dilation. One day after the procedure, the patient experienced hemodynamic instability, abdominal tenderness and distention, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An abdominal CT scan revealed massive colonic dilation with interposition of the splenic flexure into the diaphragm. Consequently, the patient underwent emergency exploratory laparoscopy, which was later converted to upper laparotomy, during which colonic decompression was performed without identifying any evidence of incarceration. Subsequently, colonic decompression was repeated via sigmoidoscopy, and no mechanical obstruction was found. Lastly, medical treatment was effective in improving the patient's condition CONCLUSIONS In this complicated case, identifying the definite diagnosis was challenging due to the unusual presentation. This rare case might contribute to recognizing a new risk factor for postoperative colonic obstruction, which is preoperative colonic dilation. Also, this case has highlighted the importance of promptly diagnosing postoperative Ogilvie's syndrome to prevent large-bowel perforation.

Percutaneous endoscopic cecostomy for management of Ogilvie's syndrome: a case series and literature review with an update on current guidelines (with video).

INTRODUCTION: Percutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endoscopy were recently published by three major expert societies, all within the last 2 years. PATIENTS AND METHODS: We retrospectively identified three consecutive patients who underwent PEC placement at a Czech tertiary referral center between May 2018 and December 2021: all for recurrent ACPO. In addition, we summarized the current guidelines in order to present the latest knowledge related both to the procedure and management approach in patients with ACPO. RESULTS: The placement of PEC was successful and resulted in clinical improvement in all cases without any adverse events. CONCLUSION: The results of our experience are in line with previous reports and suggest that PEC may become a very useful tool in the armamentarium of modalities utilized to treat ACPO. Furthermore, the availability of guideline resources now offers comprehensive guidance for informed decision-making and the procedural aspects.

Acute Colonic Pseudo-obstruction: Colonoscopy Versus Neostigmine First?

INTRODUCTION: Neostigmine (NEO) and decompressive colonoscopy (COL) are two efficacious treatment modalities for acute colonic pseudo-obstruction (ACPO). We hypothesize that a COL first strategy is associated with better outcomes compared to a NEO first strategy. METHODS: A single-center retrospective analysis was performed from 2013 to 2020. Patients ≥18 y with a diagnosis of ACPO were included. The outcome was a composite measure of acute operative intervention, 30-day readmission with ACPO, and 30-day ACPO-related mortality. A P-value of ≤ 0.05 indicated statistical significance. RESULTS: Of 910 encounters in 849 patients, 50 (5.5%) episodes of ACPO in 39 patients were identified after exclusion of one patient with colon perforation on presentation. The median (interquartile range) age was 68 (62-84) y. NEO and COL were administered in 21 and 25 episodes, respectively. In 16 (32%) episodes, no NEO or COL was administered. When patients were given NEO first, COL or additional NEO was required in 12/18 (67%) compared with a COL first strategy where a second COL and/or NEO was given in 5/16 (32%) (P = 0.05). Both strategies had similar outcomes (NEO, 4/18 versus COL, 4/16, P = 0.85). Twenty-two (44%) episodes had an early intervention (≤48 h) with NEO and/or COL. There was no difference in outcome between those that received an early intervention and those who did not (5/22 versus 5/28, P = 0.71). CONCLUSIONS: For patients failing conservative measures, a COL first approach was associated with fewer subsequent interventions, but with similar composite outcomes compared to a NEO first approach. Early (≤48 h) intervention with NEO and/or COL was not associated with improved outcomes.

Acute Colonic Pseudo-Obstruction.

CASE SUMMARY: A 33-year-old man with a history of chronic alcohol use, generalized anxiety disorder, and hypertension presented to the emergency department after a syncopal event. He was admitted to the medical intensive care unit for alcohol withdrawal, requiring intubation and sedation. On hospital day 7, abdominal x-ray image demonstrated a dilated cecum to 12 cm, transverse colon dilation to 7 cm, and decompressed distal colon ( Fig. 1 ). CT scan of the abdomen and pelvis confirmed dilation of the cecum and ascending and transverse colons ( Fig. 2 ). Colonoscopy showed no evidence of distal obstruction, but colonic distension persisted, and he subsequently underwent cecal decompression with an open "blow-hole" cecostomy fully matured at skin level via a small right lower quadrant incision. The nasogastric tube was removed on postoperative day 2, and his diet was slowly advanced. Abdominal x-ray image on postoperative day 5 demonstrated no colonic dilation. He was discharged home on postoperative day 7. The patient re-presented to the hospital 3 months later with cecostomy prolapse. He underwent cecostomy takedown with ileocecectomy via circumstomal incision. He was discharged home on postoperative day 2.

Colostomy as a definitive treatment in an ALS patient with acute colonic Pseudo-obstruction refractory to medical management, a case report.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease, and ALS patients may experience disturbed gastrointestinal motility often resulting in acute colonic pseudo-obstruction (ACPO). There is currently a paucity in the literature to guide the treatment of patients with both ALS and ACPO. CASE PRESENTATION: Here we describe a 39-year-old male patient with advanced ALS who developed ACPO. His condition was refractory to both medical and procedural managements including polyethylene glycol, senna, and docusate suppository, metoclopramide, linaclotide, erythromycin, prucalopride, neostigmine, and repeated colonoscopies. He ultimately underwent successful colostomy for palliation. Here we report the peri-operative multidisciplinary approach taken with this case, the surgical procedures, the potential risks, and the outcome. CONCLUSION: The patient is delighted with the result and requested publication of this case to raise awareness of constipation in ALS patients and promote the consideration of colostomy as a treatment option for patients with ileus resistant to conservative management. Ultimately, a multidisciplinary team approach is required to properly assess the risks and benefits to achieve good clinical outcomes.

[Ogilvie´s syndrome as a rare complication of lumbar stenosis surgery: report of two cases and literature review]. / Syndrome d'Ogilvie, une complication rare de la chirurgie du canal lombaire étroit: à propos de deux cas et revue de la littérature.

Ogilvie´s syndrome is an acute colonic pseudo-obstruction, characterized by massive colonic distension in the absence of mechanical cause. It is a very rare pathology after spinal surgery. We report two cases in the neurosurgery department of the University Hospital of Guadeloupe. A 79-year-old woman overweight (BMI= 27kg/m2) and a 56-year-old man experienced history of non-systematized bilateral lumbar and sciatic pain with reduction in walking perimeter for few months. MRI of lumbar spine had revealed a lumbar stenosis with disc herniation. They had undergone decompression surgery with laminectomy. The surgical intervention was uneventful perioperatively. By 48 hours after surgery, they had complained of constipation with cessation of fecal and flatus with resultant abdominal distension. Abdominal CT scan and X-rays showed significant bowel distension with no mechanical obstruction, suggestive of Ogilvie´s syndrome. Conservative treatment had been sufficient to treat this syndrome and the patients completely recovered. In the occurrence of Ogilvie´s syndrome, the most frequent pathology is the lumbar disc herniation. The clinical presentation is typical with a cessation of fecal and gas elimination, and abdominal distension. Conservative treatment remains the treatment of choice when diagnosis is made early.

Fatal Ogilvie's syndrome after hip surgery and review of the literature.

Ogilvie's syndrome refers to a massive dilation of the colon without mechanical obstruction. Although this syndrome is well-known in the clinical literature and may sometimes be encountered as a complication of abdominal, pelvic, or hip surgery, it has only been reported sporadically in the forensic literature. We present the case of a forensic autopsy carried out on a patient whose death was related to cecal necrosis with acute peritonitis due to Ogilvie's syndrome following hip surgery. This diagnosis was based on clinical data, post-mortem imagery, autopsy findings, histological analysis, post-mortem chemistry, and microbiological analysis. A review of the literature and possible physiopathology of this disease are performed, while focusing on medico-legal perspectives.

Ogilvie's syndrome-is there a cutoff diameter to proceed with upfront surgery?

PURPOSE: Although Ogilvie's syndrome was first described about 70 years ago, its etiology and pathogenesis are still not fully understood. But more importantly, it is also not clear when to approach which therapeutic strategy. METHODS: Patients who were diagnosed with Ogilvie's syndrome at our institution in a 17-year time period (2002-2019) were included and retrospectively evaluated regarding different therapeutical strategies: conservative, endoscopic, or surgical. RESULTS: The study included 71 patients with 21 patients undergoing conservative therapy, 25 patients undergoing endoscopic therapy, and 25 patients undergoing surgery. However, 38% of patients (n = 8) who were primarily addressed for conservative management failed and had to undergo endoscopy or even surgery. Similarly, 8 patients (32%) with primarily endoscopic treatment had to proceed for surgery. In logistic regression analysis, only a colon diameter ≥ 11 cm (p = 0.01) could predict a lack of therapeutic success by endoscopic treatment. Ninety-day mortality and overall survival were comparable between the groups. CONCLUSION: As conservative and endoscopic management fail in about one-third of patients, a cutoff diameter ≥ 11 cm may be an adequate parameter to evaluate surgical therapy.

Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) after Hip Arthroplasty.

Ogilvie's syndrome is a clinical entity that occurs with signs of excessive dilatation of the colon and obstruction, despite the absence of a mechanical obstruction. Although its etiology remains uncertain, anticholinergic drugs, metabolic disorders, diabetes mellitus, hyperparathyroidism, Parkinson's disease, major orthopedic interventions, or blunt abdominal trauma are considered to be possible causes. Imbalance in sympathetic innervation plays a role in the pathogenesis. The characteristic feature of the syndrome is the presence of a major trauma or surgical history. Although this is an uncommon complication, especially after hip and knee arthroplasty, it is an important cause of mortality and morbidity. Conservative or surgical colonic decompression and anticholinergic agents play a role in the treatment of Ogilvie's syndrome, which is defined as acute colonic pseudo-obstruction (ACPO). In this case report, we present the postoperative process of an elderly patient with comorbid diseases who underwent hemiarthroplasty due to a hip fracture as a result of a domestic fall. We will discuss the diagnosis of ACPO and the approach to multidisciplinary management of the treatment in a case that is frequently encountered in daily practice and starts as a normal report. We aim to remind surgeons that they may encounter ACPO in the postoperative period and to emphasize that mortality and morbidity can be reduced with early diagnosis and a multidisciplinary approach. We would like to emphasize that Ogilvie's syndrome should be included in the differential diagnosis portfolio of all orthopedic surgeons.

The rare Ogilvie's Syndrome in pregnancy. How to manage? A case report and literature review.

Acute colonic pseudo-obstruction, or Ogilvie's syndrome (OS), is a complication in gynaecology and obstetrics. Its occurrence during pregnancy is rare, redefining the therapeutic decision-making and treatment options. In this review we describe the case of a 37-year-old pregnant patient who developed OS at the 30th week of gestation. A laparotomy with colonic decompression was performed. Foetal condition, regularly monitored throughout the hospital stay, remained normal. The patient experienced an uncomplicated, natural delivery at 40 weeks. A comprehensive literature search, describing the occurrence of OS during pregnancy, was conducted. We identified six cases of OS arising during pregnancy. Demographic, clinical, diagnostic and therapeutic features were analysed. Non-surgical management is generally the first-line option, with intravenous drug administration, rectal and nasogastric tube positioning and colonoscopic decompression the treatments of choice. Surgical decompression in usually performed in cases of failure of the first-line treatments. Including our own experience, in all cases, neither maternal nor foetal mortality was reported. A conservative approach is mandatory as first-line treatment, but when prompt resolution is not achieved, a multidisciplinary team, involving the gynaecologist/obstetrician, the surgeon, the radiologist and the intensivist is mandatory to avoid diagnostic delays, thereby reducing morbidity and mortality rates.

Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report.

BACKGROUND: Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications. CASE PRESENTATION: A 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later. CONCLUSION: Ogilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.

Chilaiditi's and Ogilvie syndromes

No disponible

Colonic Decompression Reduces Proximal Acute Colonic Pseudo-obstruction and Related Symptoms.

BACKGROUND: Colonoscopic decompression is performed in inpatients for management of acute colonic pseudo-obstruction. Evidence for its efficacy is limited to small descriptive studies published before the use of neostigmine for acute colonic pseudo-obstruction. Furthermore, therapeutic end points were not defined. OBJECTIVE: The aim was to compare the effectiveness of colonic decompression with standard medical therapy (supportive and pharmacologic therapy) to standard medical therapy alone. DESIGN: This is a retrospective, propensity-matched study. SETTING: The study was conducted at a tertiary care center. PATIENTS: Inpatients with first diagnosis of acute colonic pseudo-obstruction between 2000 and 2016 were selected. INTERVENTIONS: The intervention group received colonic decompression as well as supportive and/or pharmacologic therapy. The control group did not receive colonic decompression. MAIN OUTCOME MEASURES: The primary outcome was the resolution of overall colonic dilation on imaging 48 hours following colonic decompression or the initiation of standard medical therapy alone. Secondary outcomes included symptom improvement, colonic segment diameter percentage change, perforation, 30-day readmission, and all-cause mortality. RESULTS: The standard medical therapy and colonic decompression groups included 61 and 83 patients. Of the patients who underwent colonic decompression, 47.7% had complete resolution of acute colonic pseudo-obstruction versus 19.9% of patients who underwent standard medical therapy (p < 0.001). There were no significant differences in mid or distal colon diameter reduction between groups. The 30-day readmission rate was 15.7% in the colonic decompression group versus 26.2% in the standard medical therapy group. No immediate adverse events were noted in either group. Thirty-day all-cause mortality was 8.4% for the colonic decompression group and 14.8% in the standard medical therapy group. LIMITATIONS: The study was a retrospective review on a highly comorbid population. CONCLUSIONS: Colonic decompression is effective compared to standard medical therapy alone for proximal colonic dilation or symptoms associated with acute colonic pseudo-obstruction. On segmental analysis, colonic decompression does not provide any additional benefit over standard medical therapy in improving transverse or distal colonic dilation. See Video Abstract at http://links.lww.com/DCR/B32. LA DESCOMPRESIÓN COLÓNICA REDUCE LA PSEUDOOBSTRUCCIÓN COLÓNICA AGUDA PROXIMAL Y LOS SÍNTOMAS RELACIONADOS.: La descompresión colonica se realiza en pacientes hospitalizados para el tratamiento de la pseudoobstrucción colónica aguda. La evidencia de su eficacia se limita a pequeños estudios descriptivos antes del uso de neostigmina para la pseudoobstrucción colónica aguda. Además, los puntos finales terapéuticos no se definieron.El objetivo fue comparar la efectividad de la descompresión colónica mas el tratamiento médico estándar (tratamiento de apoyo y farmacológico) contra el tratamiento médico estándar solamente.Este es un estudio retrospectivo de propensión coincidente.El estudio se realizó en un centro de atención de tercer nivel.Pacientes hospitalizados con diagnóstico de pseudoobstrucción colónica aguda entre 2000 y 2016.El grupo de intervención recibió descompresión colónica, así como tratamiento de apoyo o farmacológica. El grupo control no recibió descompresión colónica.La medida de resultado primaria fue la resolución de la dilatación colónica general en la imagen 48 horas después de la descompresión colónica o el inicio del tratamiento médico estándar solo. Los resultados secundarios incluyeron mejoría de los síntomas, cambio porcentual en el diámetro del segmento colónico, perforación, reingreso a los 30 días y mortalidad por cualquier causa.La terapia médica estándar y los grupos de descompresión colónica incluyeron 61 y 83 pacientes, respectivamente. El 47,7% de los pacientes con descompresión colónica tuvieron una resolución completa de la pseudoobstrucción colónica aguda frente al 19,9% de los pacientes con terapia médica estándar (p < 0,001). No hubo diferencias significativas en la reducción del diámetro del colon medio o distal entre los grupos. La tasa de reingreso a los 30 días fue del 15,7% en el grupo de descompresión colónica frente al 26,2% en el grupo de tratamiento médico estándar. No se observaron eventos adversos inmediatos en ninguno de los dos grupos. La mortalidad por cualquier causa a los 30 días fue del 8.4% para la descompresión del colon y del 14.8% en los grupos de terapia médica estándar.El estudio fue una revisión retrospectiva en una población altamente comórbida.La descompresión colónica es efectiva en comparación con el tratamiento médico estándar solo para la dilatación del colon proximal o los síntomas asociados con la pseudoobstrucción colónica aguda. En el análisis segmentario, la descompresión colónica no proporciona ningún beneficio adicional sobre el tratamiento médica estándar para mejorar la dilatación colónica transversal o distal. Vea el resumen del video en http://links.lww.com/DCR/B32.

Novel technique of insertion of decompression tube for Ogilvie's syndrome/colonic pseudo-obstruction.

Novel technique of management of colonic pseudo-obstructing using colonoscopy guided insertion of decompression tube.

Colonic pseudo-obstruction in a patient with Sheehan's syndrome.

A 56-year-old woman with a history of hypothyroidism and chronic constipation presented with an acute abdomen due to colonic pseudo-obstruction. Thyroid function tests were consistent with central hypothyroidism prompting intravenous administration of stress-dose glucocorticoids and levothyroxine. The patient then underwent emergency exploratory laparotomy with sigmoid resection and end-colostomy. The postoperative endocrine evaluation revealed that the patient had panhypopituitarism due to Sheehan's syndrome (SS). The diagnosis had been missed by physicians who had been treating her for several years for presumed primary hypothyroidism with a low dose of levothyroxine, aimed at normalising a minimally elevated thyroid-stimulating hormone (TSH) level. This is the second reported case of SS presenting with colonic pseudo-obstruction and it illustrates the potential danger of relying on measurement of TSH alone in the evaluation and treatment of thyroid dysfunction.

Appendiceal fat stranding on CT: a red herring in a post-caesarean section woman with Ogilvie's syndrome (OS).

A 30-year-old woman was referred for a surgical review with abdominal pain and distension 2 days post-caesearean section. Abdominal X-ray showed dilated bowel loops. CT of her abdomen however showed fat stranding around a thickened appendix, suggesting a differential diagnosis of acute appendicitis on top of a postoperative ileus. Failure to respond to intravenous antibiotics led to an emergent surgical exploratory laparotomy, by which time the progressive caecal dilatation had led to patchy necrosis and perforation of the right hemicolon intra-operatively. The patient required a right hemicolectomy and histological examination of the excised bowel supported the diagnosis of Ogilvie's syndrome. This case highlights the red herrings that one can encounter when faced with a woman with post-caesarean section abdominal pain and aims to raise awareness among clinicians of this condition-where timely diagnosis and management is key.