Abstract
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a massive dilation of the colon in the absence of mechanical obstruction. Treatment measures may include anticholinergic agents such as neostigmine, colonoscopy, or fluoroscopic decompression, surgical decompression, and partial or complete colectomy. We reviewed the case of a 26-year-old male with cerebral palsy who had a history of chronic intermittent constipation who presented to the emergency department (ED) with signs of impaction despite recurrent fleet enemas and oral polyethylene glycol 3350. The patient was found to have a massive colonic distention of 26 cm likely because of bowel dysmotility, consistent with ACPO. This article includes a discussion of the literature and images that represent clinical examination, x-ray, and computed tomography (CT) findings of this patient, who successfully underwent conservative management only. Emergency department detection of this condition is important, and early intervention may prevent surgical intervention and associated complications.
Highlights
Acute colonic pseudo-obstruction (ACPO), known as Ogilvie syndrome or acute colonic ileus, is a serious condition that can be relatively misdiagnosed and a patient’s presentation ascribed to both minor conditions, such as functional constipation, and major conditions, like mechanical bowel obstruction
Acute colonic pseudo-obstruction is a distention of the colon caused by decreased motility in the absence of mechanical obstruction
ACPO commonly occurs in association with a severe medical or surgical illness
Summary
Acute colonic pseudo-obstruction (ACPO), known as Ogilvie syndrome or acute colonic ileus, is a serious condition that can be relatively misdiagnosed and a patient’s presentation ascribed to both minor conditions, such as functional constipation, and major conditions, like mechanical bowel obstruction. It is important for the emergency physician to be familiar with this entity and its management in order to avoid unnecessary morbidity in these cases. The patient did not develop worsening signs of sepsis or perforation, and was discharged in improved and stable condition
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