Acute Colonic Pseudo-obstruction Research Articles

Acute colonic pseudo-obstruction or Ogilvie’s syndrome − A rare complication in the postnatal period: A case report

ABSTRACT Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is a form of colonic dilation occurring without underlying mechanical or anatomic etiology. It is a disorder of imbalance in motor innervation of the large intestine, which causes acute colon obstruction in the absence of any physical obstruction. It is associated with high morbidity and mortality due to diagnostic dilemmas and the need for surgical intervention. In gynecological practice, it rarely occurs after a cesarean section. Here, we present a case of Ogilvie syndrome after a cesarean section. The patient developed colonic pseudo-obstruction on the first postoperative day. The patient was managed conservatively using a flatus tube and improved. Ogilvie syndrome should be suspected in a patient with abdominal distension in the postoperative period after ruling out common conditions. Early suspicion and immediate decompression using a flatus tube can improve the outcome of the patient.

A rare case of acute colonic pseudo-obstruction leading to colonic perforation in a ventilated patient with cerebrovascular accident

Acute pseudo-colonic obstruction in a patient with a functioning ileocecal valve can be risky, resulting in closed-loop obstruction, significant distention of the colon, and increased chances of colon perforation and ischemia if diagnosis and timely non-operative treatments are delayed. We report a case of acute pseudo-colonic obstruction with closed-loop obstruction, resulting in colon perforation in a ventilated patient with a cerebrovascular incident. The situation was promptly identified during the first assessment with a surgical consultation and imaging study, resulting in timely surgical intervention which included removing the diseased section of the right colon, creating an end ileostomy, and colostomy. The postoperative contrast study of the remaining colon and colonoscopy confirmed the pseudo-obstruction without finding any blockages in the distal colon and rectum. After the operation, the patient recovered well and was sent home. In conclusion, early clinical suspicion, diagnosis, and prompt management of a complicated ACPO result in a good patient outcome.

8634 Ogilvie Syndrome As A Rare Complication Of Metastatic Pheochromocytoma

Abstract Disclosure: S.K. Beeby: None. J.C. Marcayata, MD: None. D.P. Di Matteo, MD: None. F.F. Souza, MD: None. I.C. Souza, MD: None. M.F. Azevedo, MD: None. F.M. Coelho, MD: None. A. Latronico, MD: None. B.B. Mendonca: None. M.C. Fragoso: None. M.Q. Almeida: None. Background: Ogilvie's Syndrome (acute colonic pseudo-obstruction) is a rare manifestationof pheochromocytoma and paraganglioma. Its pathophysiology can be explained by thehypersecretion of catecholamines, which may reduce peristaltic activity of the gastrointestinaltract due to alpha-adrenergic stimulation. We present here the case of a patient with acuteintestinal pseudo-occlusion due to metastatic pheochromocytoma. Clinical Case: A 60-year-old male with local recurrence of pheochromocytoma presentedwith abdominal pain, anorexia, nausea, vomiting and constipation for 2 weeks. The patientunderwent left adrenalectomy and nephrectomy to resect a 7.5 cm pheochromocytoma 6years ago. On examination, his blood pressure was 186 x 122 mmHg and heart rate was 112bpm. There was abdominal distention and diminished bowel sounds. Diaphoresis was notedmainly at night. Plasma fractionated metanephrines were markedly elevated, withnormetanephrine of 50.2 nmol/L (reference range <0.9 nmol/L) and metanephrine of 0.4nmol/L (reference range <0.5 nmol/L). Abdominal CT scan showed neoplastic lesionoccupying the left adrenal space, measuring 9.0 x 5.0 x 5.5 cm, infiltrating the spleen andpancreatic tail, and para-aortic and aorto-caval lymphomegaly of 1.3 cm. The large intestinewas distended with gas and lodged stool without evident obstructive factors. He was thenstarted on a high-sodium diet and alpha-blocker doxazosin 2 mg tid and propranolol 40 mgtid. Due to the presence of significant orthostatic hypotension, amlodipine 5 mg bid wasinitiated to control blood pressure. Laxatives and enemas were not effective in relieving hissymptoms and decompression with a nasogastric tube was necessary. The patient was thenput on subcutaneous neostigmine, an acetylcholinesterase inhibitor. Unfortunately, colonicpseudo-obstruction did not revert with pharmacological treatment and parenteral nutritionwas started. Since a complete tumor resection was not possible due to extensive invasion oflarge vessels, systemic cytotoxic chemotherapy (cyclophosphamide, vincristine anddacarbazine) was initiated as an attempt to treat the colonic pseudo-obstruction. Clinical lessons: Functioning pheochromocytoma and paraganglioma should be consideredin the differential diagnosis of constipation and acute intestinal obstruction, particularly whenaccompanied by other signs and symptoms of catecholamine excess. This condition should bepromptly diagnosed and managed, as it can lead to bowel perforation with seriouscomplications. Medical management includes alpha-blocking agents and, when feasible,tumor resection has been associated with good response. Support: This work was supported by Sao Paulo Research Foundation (FAPESP) grant2019/15873-6 (to M.Q. Almeida). M.Q.A was also supported by National Council forScientific and Technological Development (CNPq) 304091/2021-9. Presentation: 6/1/2024

S3126 Acute Colonic Pseudo-Obstruction: A Case Highlighting Pitfalls in Imaging

S3126 Acute Colonic Pseudo-Obstruction: A Case Highlighting Pitfalls in Imaging

Intravenous and Subcutaneous Administration of Neostigmine for Acute Colonic Pseudo Obstruction A Short Review

Acute Colonic Pseudo Obstruction ACPO also known as Ogilvies Syndrome is a rare postsurgical complication characterized by acute dilation of the colon without anatomical obstruction Neostigmine is increasingly used to manage ACPO when conservative measures fail Intravenous neostigmine has historically been favored for its rapid onset and effectiveness; however it can cause adverse effects particularly bradycardia necessitating close cardiac monitoring

An uncommon orthogeriatric syndrome: a case of Ogilvie’s syndrome

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is an uncommon postoperative complication of major orthopedic surgery that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality. Most patients who had Ogilvie’s syndrome had risk factors that could be identified preoperatively, such as immobility, elevated comorbidity, and polypharmacy, prefiguring the frail elderly patient. In modern terms, it is considered a typical orthogeriatric syndrome. In these kinds of patients, we need to be vigilant for its development and judicious in the use of epidural anesthesia. We present an ACPO case in an elderly frail patient with a hip fracture, and we review the available literature to outline clinical characteristics and outcomes. Our patient presented numerous risk factors for developing the syndrome in the preoperative period: nonautonomy in basic and daily living activities, polypharmacotherapy, spinal trauma, and hyposodiemia. In this patient, epidural anesthesia was an additional risk factor. The purpose of this case report is to emphasize the presence of this rare syndrome (1.5% of orthogeriatric patients) in orthogeriatric departments and to identify not only pharmacological, traumatic, and electrolytic risk factors but also those that can be identified even through geriatric evaluation to avoid the use of anesthesiologic techniques and drugs that may have an impact on the prognosis of these patients.

Acute colonic pseudo-obstruction: a retrospective review of the surgical outcomes

Acute colonic pseudo-obstruction: a retrospective review of the surgical outcomes

Acute colonic pseudo-obstruction in polytrauma patients.

Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aimed to explore risk factors and clinical outcomes of ACPO in polytrauma patients and contribute information to the limited literature on this condition. This retrospective study, conducted at a Level 1 trauma center, analyzed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was used. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors. There were 57 cases of ACPO, with an incidence of 1.7 per 1,000 patients, rising to 4.86 in major trauma. Predominantly affecting those older than 50 years (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPBs) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and shock index >0.9, Injury Severity Score >18, opioid use, RPBs, and pelvic fractures. A cecal diameter of ≥12 cm had a significant association with cecal ischemia or perforation. This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPBs, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favorable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients. Prognostic and Epidemiological; Level IV.

Management of acute colonic pseudo-obstruction: opportunities to improve care?

Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines. This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment. A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45. ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.

A119 ACUTE COLONOC PSEUDO-OBSTRUCTION AFTER ENDOSCOPIC RESECTION OF A FULLY CIRCUMFERENTIAL LARGE NON-PEDUNCULATED COLORECTAL POLYP

Abstract Background Complex large non-pedunculated colorectal polyps (LNPCPs), including those involving the full circumference of the bowel, are now readily managed by minimally invasive endoscopic resection techniques. Established procedure-related adverse events include sedation related adverse events, deep mural injury, clinically significant post-resection bleeding, delayed perforation and serositis. An appreciation for potential procedure-related adverse events is critical to the effective implementation of these techniques. Aims To describe a case of acute colonic pseudo-obstruction after endoscopic resection of a fully circumferential LNPCP. Methods Case report and review of the literature Results A 91-year-old male with a history of atrial fibrillation, chronic kidney disease and suspected McKittrick-Wheelock syndrome underwent successful endoscopic mucosal resection (EMR) of a 100mm fully circumferential LNPCP in the sigmoid colon. Histopathology diagnosed a tubulovillous adenoma with high-grade dysplasia. After elective admission, he suffered from clinically significant post-EMR bleeding requiring 2 units of packed red blood cells. On post-operative day 1 he began to suffer from nausea, abdominal pain and obstipation. On examination, he was visibly distended. Abdominal X-ray revealed extensive gas-filled loops of small and large bowel with the absence of gas in the rectum. He was managed conservatively with nasogastric tube decompression. Total duration of hospital stay was 9 days. Conclusions Critical to the continued expansion of minimally invasive endoscopic resection techniques is an awareness for potential procedure-related adverse events. To our knowledge this is the first description of acute colonic pseudo-obstruction after endoscopic resection Funding Agencies None

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review for Residents.

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review for Residents.

Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors

Acute Colonic Pseudo-Obstruction (ACPO): An Expanding Colon with Unusual Risk Factors

TOGA Therapeutic Oxygen for Gastrointestinal Atony

Background and aimsIleus, mechanical bowel obstruction and acute colonic pseudo-obstruction [ACPO] are characterized by distension of the intestines with accumulated bowel gas. Current treatments are not completely satisfactory. MethodsBy manipulating the partial pressures of oxygen and nitrogen in the trapped air with a novel 6-hour treatment with 100% oxygen via non-rebreather mask [NRB], the bowel can be successfully decompressed, facilitating resolution of the underlying condition. ResultsA positive clinical response was seen in 7/8 [87.5%] patients after TOGA [therapeutic oxygen for gastrointestinal atony]. Maximal lumen diameter decreased by an average of 1.14 ± 0.87 cm [16%]. ConclusionsIn this first clinical report of TOGA, the provision of 100% oxygen via NRB is a useful therapy. It decreased the diameter of the intestinal lumen and enhanced resolution of ileus, ACPO, and bowel obstruction. This is a low-morbidity, low-cost treatment of gastrointestinal luminal distension. ClinicalTrials.gov Identifier NCT03386136.st

Histologic findings in Ogilvie’s syndrome

Abstract Introduction/Objective Ogilvie Syndrome also known as acute colonic pseudo-obstruction is a rare condition characterized by massive dilation of the colon in the absence of a mechanical obstruction. Leading risk factors include critically ill or hospitalized patients with electrolyte disturbances, in the setting of surgery or trauma. It can be managed conservatively, but if unrecognized and untreated, can lead to life-threatening complications such as ischemic colitis. The purpose of this report is to describe a case with this complication and its relevant histopathological findings. Methods/Case Report A 79-year-old male who had recently undergone radical cystoprostatectomy for urothelial carcinoma presented with significant abdominal distention and unstable vital signs. CT scan showed severe cecal dilation with pneumatosis and portal venous gas concerning for ischemia and perforation. The patient subsequently underwent total colectomy. Grossly, the segment of colon showed areas of mucosal sloughing with a hyperemic and indurated serosal surface. Microscopically, the sections showed surface erosions, acute inflammatory exudate (pseudomembranes), attenuated crypts, crypt cytoplasmic mucin loss and vascular congestion, compatible with ischemic changes. In the absence of recent major surgery and critical condition pointing towards Ogilvie's syndrome, these findings can elicit the differential diagnosis of infectious colitis, drug-mediated injury, and inflammatory bowel syndrome. Results (if a Case Study enter NA) N/A Conclusion This case highlights that Ogilvie’s syndrome can histologically manifest as ischemic colitis and emphasizes that in absence of clinical impression of this syndrome a broader differential diagnosis should be entertained.

Acute Colonic Pseudo-Obstruction: A Comprehensive Review

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare but potentially life-threatening condition characterized by a large dilation of the colon without any physical blockage. It predominantly affects elderly individuals with multiple underlying health conditions, postoperative patients, and those receiving medications that impact gastrointestinal motility. The exact underlying mechanisms leading to ACPO remain unclear, but it is believed to result from dysfunction in the autonomic neural system, causing impaired colonic motility. Patients with ACPO typically present with symptoms such as abdominal distension, pain, and constipation. The diagnosis of ACPO is established based on clinical assessment, X-ray imaging, and the exclusion of mechanical obstruction. Treatment for ACPO involves promptly identifying and addressing any underlying medical conditions that may contribute to its development, such as correcting electrolyte imbalances or discontinuing medications with gastrointestinal side effects. Non-invasive measures, such as decompressing the colon using a rectal tube or administering a medication called neostigmine, are often effective in relieving symptoms. In refractory cases where conservative measures fail, surgical intervention may be necessary. Despite the rarity of ACPO, its potential for significant morbidity and mortality emphasizes the importance of promptly recognizing and managing the condition. Healthcare providers should exercise caution in patients with risk factors and clinical features suggestive of ACPO. By understanding the pathophysiology and promptly initiating appropriate interventions, healthcare professionals can optimize outcomes and minimize the potential complications associated with ACPO.

Ogilvie Syndrome: A Comprehensive Review of Pathophysiology, Clinical Presentation, and Management Strategies

Ogilvie Syndrome, also known as acute colonic pseudo-obstruction, is a rare but clinically significant gastrointestinal disorder characterized by marked colonic dilation in the absence of mechanical obstruction. This condition often presents with abdominal distension, discomfort, and obstipation, leading to substantial morbidity and mortality if not promptly recognized and managed. Despite its infrequent occurrence, Ogilvie Syndrome poses a diagnostic and therapeutic challenge to healthcare providers. This comprehensive review aims to elucidate the pathophysiological mechanisms underpinning this syndrome, detail the diverse clinical manifestations, and discuss the evolving strategies for diagnosis and management. With a focus on the latest advancements in medical and interventional therapies, this article provides a comprehensive overview of Ogilvie Syndrome, equipping clinicians with essential knowledge to improve patient outcomes.

S2322 Acute Colonic Pseudo-Obstruction Requiring Total Abdominal Colectomy in Well-Controlled Inflammatory Bowel Disease

S2322 Acute Colonic Pseudo-Obstruction Requiring Total Abdominal Colectomy in Well-Controlled Inflammatory Bowel Disease

Acute colonic pseudo-obstruction post-cesarean section is not a benign entity: A case series and review of the literature.

Acute colonic pseudo-obstruction (ACPO) is an infrequent occurrence after cesarean section. Anecdotal evidence suggests that the clinical course of ACPO in the obstetric setting is different to that seen in non-pregnant adult patients with ACPO secondary to alternative causes, such as systemic illnesses, the use of certain medications, and after non-abdominal surgery. The risk of progression to ischemia and perforation, as well as the need for emergency surgery, appears to be higher after cesarean section. Here we describe the clinical course of ACPO in four patients after cesarean section from our institution, followed by a review of the literature and a discussion of the important issues surrounding this condition in the postpartum time period. The findings from our cohort of patients and the reports from the medical literature support a hands-on combined approach from a group of specialists including obstetricians, surgeons, radiologists, and enterostomal therapists. Immediate imaging followed by regular observation is mandatory for any patient being managed conservatively. Early use of endoscopic decompression should be considered for patients who are not resolving with a conservative approach. Clinical signs of peritonism or radiological signs of ischemia or perforation in patients with ACPO mandate immediate surgical intervention. Appropriate postoperative care is necessary to deal with the complex physiological and psychological consequences of emergency surgery and potential stoma formation so soon after cesarean section.

Ogilvie's Syndrome in a Patient at 23 Weeks of Pregnancy: Report of a Rare Case with Successful Surgical Intervention.

BACKGROUND Ogilvie's syndrome (acute colonic pseudo-obstruction) is a syndrome characterized by symptoms suggestive of intestinal obstruction without an identifiable mechanical cause. It presents with excessive dilation of the loops of the large intestine. The treatment options include conservative management, endoscopic methods, and surgical intervention. If appropriate treatment is not implemented promptly, this syndrome can lead to life-threatening complications for the patient. Acute colonic pseudo-obstruction typically occurs in elderly individuals with numerous chronic diseases, extensive surgeries, or trauma. In younger individuals, risk factors include gynecological procedures, pregnancy, and childbirth. CASE REPORT This work presents a case of a 30-year-old woman at 23 weeks of pregnancy. She presented with persistent abdominal pain, nausea, and vomiting for several days. The patient was initially treated at the Obstetrics Clinic, where conservative management was implemented. Due to worsening symptoms after confirming pathological distension of the colon in the magnetic resonance imaging examination, she was transferred to the surgery clinic. Due to her unstable general condition and lack of improvement with conservative treatment, she was qualified for an appendectomy with the formation of a cecostomy. The performed surgical treatment led to an improvement in the patient's condition and did not have a negative impact on the further development of the child. CONCLUSIONS Ogilvie's syndrome in pregnancy is an extremely rare condition that can lead to significant complications. Its treatment requires the coordinated efforts of a multidisciplinary team of specialists. During the course of therapy, it is important to consider the limitations imposed by pregnancy on diagnostic and therapeutic methods.

179 Postpartum Uterus Causing Mechanical Bowel Obstruction

Abstract Background Intestinal obstruction is a common surgical emergency. Common causes of mechanical large bowel obstruction include malignancy, sigmoid volvulus, and diverticular disease. Due to the risk of bowel ischaemia and perforation, large bowel obstruction requires urgent recognition and treatment to prevent morbidity and mortality. Case Presentation 35-year-old female developed nausea, vomiting and abdominal pain two days post emergency cesarian section at 39+5 weeks gestation. An abdominal X-Ray showed distended loops of large bowel and mechanical large bowel obstruction with a sigmoid transition point was diagnosed on CT. She was referred to the surgical team for further management and a flexible sigmoidoscopy under general anaesthetic was performed for decompression. Results The patient was reviewed the following day. She was asymptomatic and had opened her bowels. She was discharged from surgical follow-up at this stage following successful treatment and was able to return home with a healthy baby. Conclusions Mechanical compression from a postpartum uterus is a rare cause of mechanical large bowel obstruction, with just one previous case documented in the literature. Acute colonic pseudo-obstruction (Ogilvie syndrome) is a recognised postpartum complication, more common after cesarian section and an important differential with similar treatment options. The recommend diagnostic imagining includes abdominal x-ray and/or CT scan with early surgical referral for consideration of interventional or surgical management in patients presenting with symptoms of bowel obstruction in the postpartum period. Conservative management should include lateral decubitus position.