A Challenge Called Ogilvie´s Syndrome.

Ogilvie´s syndrome is a colonic dilation without any existing mechanical obstruction. The risk factors that cause it are not completely understood, but if untreated, the distension can result in rupture or ischaemic bowel perforation. Additionally, the existing guidelines do not agree with each other about the next steps if conservative treatment fails. We report the case of a 71-year-old woman in whom Ogilvie´s syndrome was particularly difficult to manage, and with it, we try to add clinical data to a field with scarce evidence.

[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.

Main Bronchus Stenosis Due to Tuberculosis and Ogilvie's Syndrome: A Case Report of Two Unusual Diseases in the Same Patient.

Main bronchus stenosis as a sequel of pulmonary tuberculosis is infrequent and should raise suspicion of other presentations of the infection. Given its non-specific symptomatology and the absence of a specific diagnostic method, tracheobronchial tuberculosis is usually not suspected and diagnosed despite its great impact on quality of life due to the high incidence of stenosis as a consequence. Ogilvie's syndrome, an uncommon condition, requires careful management and surveillance given the risk of ischemia and colonic perforation intrinsic to the disease. We present a case of a patient with main bronchus stenosis secondary to tuberculosis infection and Ogilvie's syndrome post-surgery.

Síndrome de Ogilvie após cirurgia citorredutorae quimioterapia hipertérmica: relato de caso / Ogilvie?s syndrome secondary to cytoreductive surgeryand hyperthermic chemotherapy: a case report

A associação entre cirurgia citorredutora com aquimioterapia intraperitoneal hipertérmica combinaa máxima citorredução do peritônio lesado ede diversas partes de órgãos lesados com a administraçãode um quimioterápico a alta temperatura.Isso permite elevada concentração da droga nolocal e potencializa seu resultado com um mínimode efeitos sistêmicos. Relata-se o caso de pacientefeminina, 39 anos, submetida a procedimentode peritoniectomia com quimioterapia hipertérmicapara câncer de ovário recidivado. Três anosantes, submeteu-se a tratamento para câncer deovário com cirurgia e quimioterapia baseado emplatina. Foi realizada uma combinação da cirurgiacitorredutora com a quimioterapia intraperitonealhipertérmica. No sétimo dia pós-operatório, apaciente teve distensão abdominal, ruídos hidroaéreosaumentados, sem eliminação de fezes ouflatos. A radiografia de abdome mostrou dilataçãoacentuada do cólon (10 cm) e o diagnósticofoi síndrome de Ogilvie. Foi introduzida sonda porvia retal, levando à eliminação de grande volumegasoso com melhora do quadro de distensão abdominal.A sonda foi mantida por quatro dias, quandoa paciente começou a eliminar flatos e aceitardieta, recebendo alta hospitalar no décimo sextodia pós-operatório.

The combination of cytoreductive surgery and hyperthermicintraperitoneal chemotherapy for the treatmentof cancer associates maximum cytoreduction ofthe injured peritoneum and other parts of lesioned organswith the administration of chemotherapy agentsat a high temperature. This results in increased levelsof the drug at the site of lesion and enhances the cytotoxiceffect of the drug with minimal systemic effects.We report the case of a 39-year-old female patient whounderwent peritonectomy with hyperthermic chemotherapyto treat a recurrent ovarian cancer. Three years earlier, the patient had undergone surgery andplatinum-based chemotherapy. A combination of cytoreductivesurgery and hyperthermic intraperitonealchemotherapy was chosen. On the seventh postoperativeday, the patient evolved with a distended abdomen,increased bowel sounds and absence of bowelmovement or flatulence. An abdominal radiographywas performed and revealed a massive colonic dilatation(10 cm). The patient was diagnosed with Olgivie?ssyndrome. A tube was inserted into her rectum and alarge volume of gas was expelled, which immediatelyreduced her abdominal distention. The tube was leftinside her colon for four days, and the patient beganto expel flatus and have a good food intake. She wasdischarged on the 16th postoperative day. Despite beinga major surgery, according to our research, this case isthe first record of Ogilvie?s syndrome developing as aconsequence of cytoreductive surgery combined withhyperthermic intraperitoneal chemotherapy.

An elderly woman with abdomen distension: Ogilvie?s or Chilaiditi syndrome? / Mulher idosa com distensão abdominal: síndrome de Ogilvie ou de Chilaiditi?

Embora a síndrome de Ogilvie ou pseudo-obstrução intestinaltenha sido poucas vezes relatada, não se trata decondição muito rara. Relata-se o estudo de caso de umamulher de 85 anos com hipocalemia em que os principaisaspectos são enfatizados, com o objetivo de aumentar oíndice de suspeita sobre essa entidade. O diagnóstico diferencialentre as síndromes de Ogilvie e de Chilaiditi érealçado, em virtude dos aspectos comuns a essas duascondições. A paciente recebeu suporte clínico geral e reposiçãohidroeletrolítica com bom resultado, após quatrodias de tratamento conservador. O diagnóstico precoce e a pronta correção de fatores predisponentes contribuírampara o sucesso do manuseio clínico da síndrome deOgilvie que afetou essa frágil paciente.

Although Ogilvie?s syndrome, or intestinal pseudoobstruction,has been scarcely reported, it is not arare condition. With the objective of raising awarenessabout this entity, the case study of an 85-yearoldwoman with hypokalaemia is reported and themain findings are emphasised. The differential diagnosisbetween Ogilvie?s and Chilaiditi syndromeis highlighted because of the features shared bythese conditions. The patient received general clinicalsupport and her hydro-electrolyte balance wasmaintained, with a good outcome after four days ofconservative treatment. Early diagnosis and promptcorrection of predisposing factors contributed tothe successful clinical management of the Ogilvie?ssyndrome affecting this fragile elderly patient.

Síndrome de Ogilvie poscesárea: a propósito de un caso y revisión bibliográfica / Ogilvie’s syndrome pos c-section: case report and bibliographical review

El Síndrome de Ogilvie o pseudo-obstrucción colónica aguda, es una entidad clínica rara, caracterizada por dilatación del intestino grueso, de instalación rápida y progresiva, sin evidencia de obstrucción mecánica, que generalmente acompaña a otras condiciones clínicas o quirúrgicas. Su fisiopatología aún se desconoce. El diagnóstico se establece por el cuadro clínico y los hallazgos en la radiografía simple y contrastada del abdomen. Dentro de las formas de tratamiento se han incluido: clínico, endoscópico, bloqueo epidural, quirúrgico y terapia farmacológica.Se reporta el caso de una paciente de 34 años edad, transferida de un hospital cantonal al hospital Gineco-obstétrico “Enrique C. Sotomayor”, quien 5 días posteriores a intervención cesárea presentó distensión abdominal progresiva, fascie séptica, inestabilidad hemodinámica. A la Rx simple se observa asas intestinales distendidas acompañadas de gran nivel hidroaéreo bilateral; en la laparotomía exploradora se encuentra gran neumoperitóneo no cuantificable, además de una perforación a nivel de la cara anterior del ciego, de 1.5cms de diámetro; se practica colectomía derecha con ileotransverso anastomosis, término lateral en dos planos. La paciente evoluciona sin novedad.

The Ogilvie’s Syndrome, or acute colonic pseudo-obstruction, is a strange clinical entity characterized by dilation of the colon, of quick and progressive installation, without evidence of mechanical obstruction, which generally accompanies other clinical or surgical conditions. It’s physiopathology is still unknown. Diagnosis is made clinically and by the discoveries in the simple and contrasted x-ray of the abdomen. In regards to the treatment options, it has been included: clinical, endoscopic, epidural blockage and surgical therapy.The case of a 34 year-old patient is reported, who was transferred from a cantonal hospital to the “Enrique Sotomayor” maternal hospital, who 5 days after C-section presented progressive abdominal distension, fever, pale-septic aspect, hemodynamic inestability. In the simple X-ray intestinal distension is observed accompanied by great bilateral hydro-air levels; in the exploratory laparotomy, main and unmeasurable pneumoperitoneo was found, besides a perforation of the anterior view of the colon, 1,5cms diameter, right colectomy was performed, along with ileal-transverse anastomosis, end-lateral in two planes. The patient evolves without novelty.