Ogilvie Syndrome in a Child With Incurable Malignancy (779)

Abstract

1.Recognize the signs and symptoms of acute colonic pseudo-obstruction (Ogilvie Syndrome) in patients with serious underlying medical conditions.2.Identify invasive and non-invasive treatment modalities for patients with Ogilive syndrome Acute colonic pseudo-obstruction. (ACPO), also known as Ogilvie Syndrome, is characterized by dilatation of the large intestine in the absence of mechanical obstruction; it usually occurs in adult patients with serious underlying medical conditions and is rarely seen in children. A 16 year-old girl, diagnosed with metastatic small cell osteosarcoma in April 2008, was referred to our quality-of-life service with incurable disease in July 2009. Her illness was complicated by ascites of unknown origin and pain secondary to extensive metastatic disease. Her pain was under reasonable control until the fall of 2010 when she began experiencing abdominal distension, gas retention, and constipation initially treated with metoclopramide and rectal tube. Progressive pain and distension resulted in an extensive evaluation, including colonoscopy, yielding the diagnosis of Ogilvie Syndrome. It is likely that chronic narcotic use, abdominal metastasis, and a paraneoplastic process contributed to development of ACPO in this patient. First line treatment for ACPO is conservative management with bowel rest and mechanical decompression. The case patient failed conservative measures and a trial of pharmacological therapy with neostigmine was undertaken based on efficacy data from the adult literature. Unfortunately, patient experienced a severe anaphylactic reaction with bronchospasm after administration of the first dose precluding future use. We urge clinicians to use caution, such as having anaphylactic medications available, if using this medication in patients with Ogilvie Syndrome and encourage further research in pediatric patients. After thoughtful reflection, the case patient elected to undergo aggressive therapy with a diverting ileostomy and had near immediate relief of her symptoms which persisted for 6 months. This case highlights an infrequent, but important, gastrointestinal complication which can occur in pediatric patients with serious co-morbid disease. It also illustrates the progression of therapies that can be undertaken to treat this disorder in children.