Ogilvie's Syndrome Research Articles

Acute Intestinal Pseudo-obstruction.

Acute pseudo-obstruction may manifest clinically in one of three forms--acute gastroparesis, ileus, and acute colonic pseudo-obstruction (Ogilvie's syndrome). Though formerly associated primarily with the postoperative state, these entities are increasingly recognized in association with a wide variety of major medical problems. There are few controlled studies to guide the clinician in the management of these disorders. Treatment remains largely empirical, and time-honored, based primarily on "bowel rest," nasogastric decompression, and supportive care. While a wide variety of pharmacologic approaches have been advocated, few have been subjected to, or survived, the rigors of a properly controlled trial. Neostigmine is a notable exception, and has been shown to be effective in Ogilvie's syndrome. Perforation is a significant threat in megacolon; colonoscopic, or surgical decompression may, therefore, be indicated. Both are associated with significant risks in this context, but may prevent progression to perforation with its attendant mortality. New approaches seek to exploit current concepts in the pathophysiology of ileus and megacolon but have not, as yet, achieved efficacy in human studies.

Ogilvie Syndrome as a Postoperative Complication

Ogilvie syndrome is a postoperative complication. Case series. University-affiliated tertiary-care hospital. The medical records of patients diagnosed as having Ogilvie syndrome after trauma or operation between 1989 and 1998 were reviewed. Medical charts were examined for history, treatment, cecal diameter, and outcome. Data were summarized in an attempt to identify patient populations at risk for Ogilvie syndrome. Ogilvie syndrome was diagnosed in 36 patients, 24 of whom were men. Average age at diagnosis was 68.9 years. Abdominal radiographs were obtained at time of diagnosis (mean cecal diameter, 13.4 cm; range, 8-20 cm). Operations preceding Ogilvie syndrome were orthopedic or spinal (n= 14), cardiothoracic (n= 12), abdominal (n= 5), and vascular (n= 2). Nonoperative trauma accounted for 3 cases. Coronary artery bypass grafting was the single most frequent procedure leading to Ogilvie syndrome (n=9 [25%]). Conservative treatment was successful in 52.8% of cases (n = 19). Twenty colonoscopic decompressions were performed on 13 patients, with an overall success rate of 77% (n= 10). Of the 3 patients in whom colonoscopic decompression failed, 2 died and 1 required operation. Five of the 36 patients required surgical intervention, with a mortality rate of 60% (n= 3). Previous studies have shown Ogilvie syndrome to occur most commonly after obstetrical/ gynecologic, abdominal/pelvic, and orthopedic procedures. Our data confirm that patients undergoing orthopedic and spinal procedures are at higher risk, but that the surgical procedure most commonly leading to Ogilvie syndrome was coronary artery bypass grafting. Cardiothoracic surgeons, orthopedic surgeons, and neurosurgeons should be cognizant of this complication in the patient whose abdomen becomes distended postoperatively. If recognized early and treated appropriately, pseudo-obstruction will resolve in most patients. If surgical intervention is required, the subsequent mortality rate is high.

Ogilvie’s Syndrome After Cesarean Delivery

Ogilvie's syndrome is a rare postsurgical complication that can be associated with cesarean delivery. It is characterized by massive dilation of the colon, much like that which occurs with an obstruction but in the absence of a mechanical obstruction. Early detection and intervention are necessary to avoid serious morbidity and/or mortality. Conservative treatment is effective in many cases, but surgical intervention may be required. Nursing assessment of the gastrointestinal system in the postsurgical patient is reviewed using a case report of a patient who developed Ogilvie's syndrome after a cesarean delivery.

Neostigmine: safe and effective treatment for acute colonic pseudo-obstruction.

Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a common and relatively dangerous condition. If left untreated, it may cause ischemic necrosis and colonic perforation, with a mortality rate as high as 50 percent. Neostigmine enhances excitatory parasympathetic activity by competing with acetylcholine for attachment to acetylcholinesterase at sites of cholinergic transmission and enhancing cholinergic action. We hypothesized that neostigmine would restore peristalsis in patients with acute colonic pseudo-obstruction. Twenty-eight patients at Fletcher Allen Health Care and The Cleveland Clinic Foundation were treated for acute colonic pseudo-obstruction with neostigmine 2.5 mg IV over 3 minutes while being monitored with telemetry. Mechanical obstruction had been excluded. Complete clinical resolution of large bowel distention occurred in 26 of the 28 patients. Time to pass flatus varied from 30 seconds to 10 minutes after administration of neostigmine. No adverse effects or complications were noted. Of the two patients who did not resolve, one had a sigmoid cancer that required resection and one patient died from multiorgan failure. This study supports the theory that acute colonic pseudo-obstruction is the result of excessive parasympathetic suppression rather than sympathetic overactivity. We have shown that neostigmine is a safe and effective treatment for acute colonic pseudo-obstruction.

Outcomes of Ogilvie S Syndrome: A marker for mortality

Outcomes of Ogilvie S Syndrome: A marker for mortality

Ogilvie's syndrome associated with acute cytomegaloviral infection after liver transplantation

Abstract Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a rare complication following liver transplantation. We describe two cases in which the onset of Ogilvie's syndrome is strongly temporally associated with acute cytomegaloviral (CMV) infection in immunosuppressed liver transplant recipients. The pseudo-obstruction resolved rapidly in both cases following treatment with intravenous ganciclovir. Acute CMV infection therefore appeared to be causally linked to pathogenesis of Ogilvie's syndrome in these two cases. This association has not been described previously to our knowledge, and should be considered in any transplant patient presenting with Ogilvie's syndrome.

OGILVIE SYNDROME IN TWO CASES

Ogilvie syndrome is an acute pseudo-obstruction of the colon without mechanical stenosis, the and pathogenesis of which is still unknown. This paper presented two cases of Ogilvie syndrome. Case 1: A 57-year-old man was admitted to the hospital because of symptoms suggesting intestinal obstruction. Through examination revealed no mechanical stenosis of the colon. Since decompression for the dilated colon using colonos-copy was not successful, sigmoidostomy was performed because of the risk of colon perforation. Case 2: A 75-year-old man with no past history of disease, was admitted with abdominal fullness and dilation of the colon. Various examinations revealed an extremely dilated colon without mechanical'stenosis, and the diagnosis of idiopathic Ogilvie syndrome was made. This case was treated by colonos-copic decompression. In the literature, colonoscopic decompression is the first treatment of choice before surgery in some cases of the Ogilvie syndrome. In this paper, two cases of Ogilvie syndrome treated endoscopically or operatively are reported.

Megacolon: Acute, Toxic, and Chronic.

Megacolon refers to cecal dilatation above the dimension of 12 cm and above 6.5 cm of the sigmoid colon, measured at the pelvic brim. Dilatation of the colon can be broadly categorized into three clinical entities: In acute megacolon (Ogilvie's syndrome), colonic dilatation is attributed to a sympathetically mediated reflex response to a number of serious medical or surgical conditions in elderly patients. The initial tasks are to exclude mechanical obstruction (with a hypaque enema), to discontinue enabling medications, and to correct metabolic disturbances. Dilatation of the cecum to greater than 12 cm diameter is a cause for grave concern. The rectum should be decompressed with an indwelling tube and tap water enemas. Intravenous neostigmine is generally effective and safe for patients with colonic distention unresponsive to such conservative therapies. Endoscopic decompression is necessary for patients who do not respond to, or relapse after neostigmine, or in whom neostigmine is contraindicated. Signs of peritonitis may imply colonic perforation, and surgery will be needed, often on an emergent basis. Toxic megacolon is secondary to an identifiable inflammation of the colon. Therapy is directed toward specific treatment for the underlying disorder, inflammatory bowel disease, or infectious colitis. Bowel rest and close monitoring of the clinical status is vital. Colectomy may be needed under emergency circumstances. Chronic megacolon may be congenital (due to Hirschsprung's disease) or may represent the end-stage of any form of refractory constipation (slow transit constipation or pelvic floor dysfunction). The initial treatment for Hirschsprung's disease is surgery, while pelvic floor dysfunction and encopresis respond to biofeedback therapy. In chronic idiopathic megacolon, medical measures, such as colonic evacuation with enemas, fiber supplementation, and laxatives may suffice. If severe motor dysfunction is confined to the colon, a subtotal colectomy with an ileorectal anastomosis, or an ileostomy may occasionally be necessary.

Radiographic changes after colonoscopic decompression for acute pseudo-obstruction.

Colonoscopy has been the principal tool for decompression in acute colonic pseudo-obstruction, known as Ogilvie's syndrome. The objectives of this study were to determine the immediate effect of colonoscopy on the cecal diameter (measured on supine radiographs) and to delineate possible correlations in the diameters of dilated segments of the colon. The charts and radiographs of 24 patients who had colonoscopic decompression for acute colonic pseudo-obstruction between 1992 and 1997 at the San Diego Veterans Affairs Medical Center and the University of California, San Diego Hospitals were reviewed. We measured cecal, transverse, descending, and sigmoid colon diameters on serial radiographs up to the point of clinical resolution. Mean +/- standard deviation cecal diameter change (between initial and post-decompression films) was -2+/-3.4 cm at four hours and -2.2+/-3.3 cm one day after decompression. On the daily radiographs between colonoscopic decompression and clinical resolution, there was a close correlation between the diameter of the cecum and that of the transverse colon (P<0.05). There was no correlation between the cecal diameter and that of the descending or sigmoid colon. Colonoscopic decompression only causes a small decrease in cecal size in the patient with acute colonic pseudo-obstruction. Dilation patterns of the cecum and transverse colon are significantly correlated in acute colonic pseudo-obstruction. This correlation provides additional support to the contention that the same pathophysiology affects these two segments of the colon.

Neostigmine and Ogilvie's Syndrome: Letting the Air Out

American Journal of Gastroenterology: November 1999 - Volume 94 - Issue 11 - p 3107 doi: 10.1111/j.1572-0241.1999.03107.x

Neostigmine for Acute Colonic Pseudo-Obstruction

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a term for massive dilation of the colon without mechanical obstruction. This condition tends

OGILVIE'S SYNDROME POST RENAL TRANSPLANT AND ITS ASSOCIATION WITH DELAYED GRAFT FUNCTION OR PRIMARY NON-FUNCTIONING GRAFT

316 Ogilvie's syndrome (acute colonic pseudo-obstruction), a known complication of retroperitoneal surgery, is a potentially serious condition that may lead to severe life threatening complications (e.g. colonic perforation or necrosis) if unrecognized. Here we report the first retrospective study showing an association between delayed graft function (DGF) or primary graft non-function (PGNF) post renal transplant and Ogilvie's syndrome (OS). Methods: All renal transplant patients with intra-abdominal complications were reviewed. Cases of acute colonic pseudo-obstruction were identified. Presence or absence of immediate renal function, cause of renal dysfunction, age, amount of narcotic analgesics and presence of retroperitoneal collections were noted. DGF was defined as lack of >15% spontaneous drop in serum creatinine by day 3 ± need for dialysis in the first week post transplant. PGNF was due to hyperacute rejection or vascular complications. Results: Between July 1993- December 1998, 511(350 cadaveric, 161 live donor) renal transplants were performed in adult patients at our institution. 15 patients had OS diagnosed by clinical picture+abdominal series±colonoscopy±contrast colon studies. Only 2 patients with OS had peri-renal fluid collection. Sixty-nine patients had DGF (67 cadaveric, 2 live donor transplant) and 11 patients had PGNF. Of 80 patients with DGF or PGNF, 11 developed OS (13.7%), compared to 4 patients with OS and immediate graft function (4/432, 0.9%) (p=0.0000, χ2 test, odds ratio=17). There was no statistically significant difference in age between patients with or without OS (mean±SD 43±14 vs 41±13 year). Patients with and without OS received equivalent narcotic analgesic in first week post transplant (424±141 mg meperidine HCl and 348±128 mg codeine phosphate vs 484±110 mg meperidine HCl and 467±122 mg codeine phosphate, respectively; differences were not statistically significant). OS was treated conservatively ± rectal tube decompression in 10 cases. Four patients had one or more colonoscopic decompression. Two patients with OS developed colonic perforation and subsequently underwent open surgery; one of them developed septic shock post-operatively and died despite aggressive treatment. Conclusion: OS is associated with DGF and PGNF post-renal transplant. To our knowledge this is the first retrospective study showing this association. Knowledge of this association can lead to early recognition of this potentially serious condition, which in turn might prevent occurrence of further complications.

Ogilvie's syndrome in the surgical patient: A new therapeutic modality

Acute colonic pseudo-obstruction, Ogilvie's syndrome, most often appears as a complication of other clinical conditions. It is characterized by massive colonic dilation in the absence of a mechanical cause. Therapy for this condition has traditionally been colonoscopic decompression via a flexible colonoscope. We performed a retrospective study to assess the efficacy of Cystografin enema for colonic decompression in Ogilvie's syndrome. We present a series of 18 patients who developed Ogilvie's syndrome while hospitalized for trauma (n = 10), burn (n = 1), gastrointestinal surgery (n = 4), and hip replacement (n = 3). The mean pre-enema cecal size was 13 cm (range 10 to 15 cm). The mean postenema cecal size was 8.5 cm (range 6 to 15 cm). Fifteen of the 18 patients underwent Cystografin enema as the primary mode of decompression. Three had undergone prior colonoscopy, which had failed. One of the 18 patients required repeat enema for inadequate decompression after the first enema and one underwent colonoscopy for recurrence. Two patients underwent operative intervention after the enema. There were no complications related to the enema. In all patients we were able to rule out a mechanical cause of large bowel obstruction. We believe the safety, efficacy, and ease of this procedure make Cystografin enema optimal firstline treatment for acute colonic pseudo-obstruction.

Ogilvie's syndrome in the surgical patients: A new therapeutic modality

Ogilvie's syndrome in the surgical patients: A new therapeutic modality

Gastrointestinal complications of dermatomal herpes zoster successfully treated with famciclovir and lactulose

Herpes zoster involving the sacral dermatomes can cause urinary retention and is sometimes associated with constipation.1-9 Pseudoobstruction (Ogilvie's syndrome) is obstruction without a physical cause. Herpes zoster can cause this syndrome, which usually results in hospitalization and often requires colonoscopic reduction of the pseudoobstruction. This complication has been postulated to be caused by local inflammation and an imbalance of the sympathetic and parasympathetic autonomic nervous systems.

Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment.

Our aim was to assess the value of a parasympathomimetic drug (neostigmine) in the early resolution of acute colonic pseudo-obstruction (Ogilvie's syndrome). A prospective study was undertaken in 18 consecutive patients (mean age, 76 (range, 31-87) years) with acute colonic pseudo-obstruction. After a varying period of conservative treatment in all cases, 16 patients with persistent, massive abdominal distention were given intravenous neostigmine. A rapid and satisfactory clinical and radiologic decompression of the large bowel was obtained in 12 patients (75 percent) after a single dose of the drug; another patient had complete resolution after a second dose, and the other 3 patients had only partial resolution, in one of them after a second dose of the drug. No patient required surgical decompression of the bowel. These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's syndrome. The treatment with intravenous neostigmine has proved very effective, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoiding surgical treatment in a consecutive series of patients.

Acute pseudo-obstruction of the colon as a postoperative complication of hip arthroplasty.

Acute pseudo-obstruction of the colon (Ogilvie syndrome) results in massive colonic dilatation that may lead to a life-threatening perforation. This complication is known to occur after arthroplasty of the hip, yet the prevalence of the complication and its effects on the outcome of the procedure are unknown. We reviewed the records of thirty patients (mean age, 74.3 years; range, fifty-six to ninety years) in whom acute colonic pseudo-obstruction developed after hip arthroplasty between 1984 and 1993. During this ten-year period, 10,468 hip arthroplasties were performed at our institution; therefore, the prevalence of acute colonic pseudo-obstruction was 0.29 per cent. The most common presenting symptom was abdominal distention, which occurred a mean of 3.5 days (range, one to eleven days) postoperatively and was noted in twenty-seven of thirty patients. Nausea (fourteen patients), vomiting (eight patients), and abdominal pain (two patients) were observed less frequently. Twenty-one associated medical complications, including pulmonary embolism (four patients), upper gastrointestinal bleeding (three patients), and deep infection (not evident intraoperatively) at the site of the arthroplasty (two patients), developed in fifteen patients. Eighteen of the twenty-one complications occurred after the onset of colonic pseudo-obstruction. The associated medical problems resulted in four deaths (13 per cent). Recognition by the orthopaedic surgeon of the presenting features of acute colonic pseudo-obstruction is important in order to facilitate prompt initiation of treatment, which may hasten recovery and reduce the morbidity and the mortality associated with this complication.

Colonic pseudo-tumor linked to Ogilvie's syndrome

We present a case of a giant colonic pseudolipoma in a patient with colonic dysmotility due to chronic Ogilvie's syndrome.

Ogilvie's syndrome in the obstetric patient

SummaryIntroductionOgilvie's syndrome or acute colonic pseudoobstruction is a rare but potentially lethal complication in the obstetric patient who presents with large bowel obstruction. It is more commonly seen after delivery by caesarean section. Treatment is initially conservative but surgical decompression may be required. If serious sequelae are to be avoided, early diagnosis and careful clinical monitoring of the condition is required.

Acute colonic pseudo‐obstruction (ogilvie's syndrome) during induction treatment with chemotherapy and all‐trans‐Retinoic Acid for acute promyelocytic leukemia

Acute colonic pseudo‐obstruction (ogilvie's syndrome) during induction treatment with chemotherapy and all‐<i>trans</i>‐Retinoic Acid for acute promyelocytic leukemia