Ogilvie Syndrome

Excerpt

Acute colonic pseudo-obstruction (ACPO), known as Ogilvie syndrome, is a distinct form of colonic dilatation without evidence of underlying mechanical or anatomic cause. Dilatation of the bowel is classically confined to the cecum and ascending colon with transition near the splenic flexure. It is most commonly encountered in older adults with multiple underlying comorbidities but may also develop in otherwise healthy patients after a traumatic injury or following a surgical operation. It is important to remember that the diagnosis of ACPO is one of exclusion and that more common causes of functional or mechanical bowel dilatation must be investigated. Symptoms and signs of the disease usually manifest over 3 to 5 days but may also develop more acutely, sometimes within 48 hours. ACPO is considered complicated when the patient develops any evidence of bowel ischemia, peritonitis, or perforation; the risk of complication increases directly with increasing cecal diameter and duration of illness. Supportive care with close observation remains the primary treatment for patients with uncomplicated ACPO, although early pharmacologic intervention is increasingly encouraged. Invasive procedures or surgery are indicated for disease refractory to conservative therapy or for those with a more severe initial presentation. Many patients recover with appropriate intervention, although morbidity and mortality increase substantially in patients who develop complications at any time during management.