S1678 Ogilvie’s Syndrome in a Patient With COVID-19 Infection

Abstract

INTRODUCTION: Ogilvie’s syndrome is characterized by colonic distension without signs of mechanical obstruction and it is caused by dysfunction of the autonomic nervous system. Common causes include infections, orthopedic surgery, renal failure, electrolyte disturbance and narcotic use. It is well known that viral infections can cause autonomic dysfunction. We present a case of Ogilvie’s syndrome which might have been caused by COVID-19. CASE DESCRIPTION/METHODS: 39-year-old male with history of HTN presented to the ED with dyspnea, fever, and cough for 8 days. Chest x-ray showed findings concerning for atypical pneumonia and PCR was positive for COVID-19. On day 6 of admission, he desaturated therefore he was intubated and transferred to the ICU. Due to prolonged constipation, patient underwent x-ray abdomen which showed gaseous distention of the colon. There was no improvement with lactulose, methylnaltrexone and enemas therefore a CT scan was done which showed distended small and large bowel loops without definite obstruction (Figure 1). Patient was started on Neostigmine and electrolytes were optimally replaced. Rectal and OG tubes was also placed. C. difficile toxin was negative. He had a bowel movement 3 days after neostigmine was started. Further management was done with enemas and he eventually started having regular bowel movements. Patient was extubated on day 23 of admission. He was gradually started on a diet and transferred to the general floor. Repeat x-ray abdomen showed improvement in colonic distention. Patient was saturating well on room air on day 35 therefore he was discharged home. DISCUSSION: Several management modalities are employed to treat Ogilvie’s syndrome including conservative measures (bowel rest, NG and rectal tubes placement and electrolyte replacement), medical therapies (neostigmine) with endoscopic decompression and surgery reserved for patients without any response to neostigmine. Cessation of medications that might exacerbate symptoms and treatment of underlying infection are important. In our patient, conservative management, neostigmine, and treatment of the underlying infection improved symptoms. Since COVID-19 is a new virus, many of the effects of this virus are yet to be discovered. It has effects on the nervous system including reports of cases of GBS, transverse myelitis, anosmia, encephalitis, and CVA. It is plausible that loss of parasympathetic spinal control of bowel motility may be one such manifestation of this disease.Figure 1.: a (coronal), 1b (axial) and 1c (sagittal) show different views of abdominal CT scan demonstrating dilated loops of large bowel (red arrows).