Acute colonic pseudo-obstruction

Eisen, Glenn M.; Baron, Todd H.; Dominitz, Jason A.; Faigel, Douglas O.; Goldstein, Jay L.; Johanson, John F.; Mallery, J. Shawn; Raddawi, Hareth M.; Vargo, John J.; Waring, J. Patrick; Fanelli, Robert D.; Wheeler-Harbaugh, Jo

doi:10.1016/s0016-5107(02)70348-9

Cited by 111 publications

(102 citation statements)

References 14 publications

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“…Supportive therapy is the preferred initial management of ACPO and should be instituted in all patients [11]. Success rates as high as 96 per cent have been achieved with conservative measures [12], but poorer results have been reported [13].…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

2016

J Syndr

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Acute colonic pseudo obstruction (ACPO), also known as Ogilvie's syndrome is a very rare postoperative complication of Caesarean section. It has classically been reported in critically ill patients and following cardiac and hip surgery. Whether this complication recurs in subsequent operations is not known. Only one case report of recurrence following caesarean section was found in literature survey. We report a case of Ogilvie's syndrome which recurred in the second Caesarean section and was successfully managed conservatively. IntroductionOgilvie's syndrome or acute colonic pseudo obstruction (ACPO) is a rare but potentially fatal postoperative complication which is characterised by severe adynamic ileus with massive colonic dilatation in the absence of mechanical obstruction. Sir William Heneage Ogilvie described this syndrome in 1948 which was subsequently named after him. It has an incidence of 0.1% approximately following major surgeries [1] like cardiac and hip surgery [2,3]. In women, caesarean section appears to be the most common surgery associated with Ogilvie's syndrome [4].We report a case of recurrent Ogilvie's syndrome in two consecutive Caesarean sections in a patient with severe pre-eclampsia. On both occasions she was successfully managed conservatively. This case is unique because it seems to be the second such reported case of post cesarean section recurrent Ogilvie's syndrome (MEDLINE with search terms pseudo obstruction, post caesarean, and recurrence). Given the rising trend of caesarean sections, it is intuitive that this rare syndrome may not remain rare in the future. Obstetricians thus need to have awareness regarding the features, preventive measures and early recognition and management of this complication because patients may have to undergo cesarean sections in more than one occasions in her lifetime. Case PresentationA 33 years old P2+0 with 2 previous caesarean sections was referred to our hospital with gradual distension of abdomen from the 5 th postoperative day of Caesarean section. She had no stool since operation but was passing flatus without any vomiting or fever. She had undergone emergency Caesarean section under spinal anaesthesia in a peripheral health unit for severe pre-eclampsia in a post caesarean pregnancy.The operative notes in the referral card mentioned that she Case Report Open Access Journal of Syndromeshad an episode of postpartum haemorrhage on the operation table which was managed by syntocinon drip, prostaglandin F2 ɑ (250 mcg I.M) and per rectal misoprostol (800 mcg). The estimated blood loss was around 1000 ml which was replaced with crystalloids and

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Section: Discussionmentioning

confidence: 99%

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

2016

J Syndr

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“…Ogilvie's syndrome commonly occurs in patients who are critically ill, have electrolyte imbalance, or on anticholinergic medications. If left untreated, life threatening complications like bowel ischemia or perforation may occur in up to 15% of cases with a mortality of 50% [5] .…”

Section: Introductionmentioning

confidence: 99%

Colonic Pseudo-Obstruction

Zaidi¹

2012

Current Concepts in Colonic Disorders

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“…The exact pathogenesis of the syndrome remains unclear, although imbalance of the autonomic nervous system affecting the colon has been proposed. 2 Unlike toxic megacolon (often caused by inflammatory bowel disease or infection), Ogilvie syndrome usually does not present with signs of systemic toxicity. Computed tomography is usually indicated for ruling out obstructive lesions or possible bowel ischemia.…”

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confidence: 99%

“…If the syndrome is left untreated, life-threatening complications such as bowel ischemia or perforation may occur in an estimated 3%-15% of patients, with a 50% reported mortality rate. 2 The success rate for nasogastric decompression with or without anal tube placement is variable (20%-92%), and colonoscopic decompression is successful in about 70% of patients. 2 A resolution rate of 80%-90% has been reported for use of neostigmine (2.0 mg intravenously) when conservative therapy has failed.…”

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confidence: 99%

Ogilvie syndrome: acute pseudo-obstruction of the colon

Hsu¹,

Wu²,

Liu³

2010

Canadian Medical Association Journal

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A 76-year-old man with a his tory of hepatitis C infection and newly diagnosed hepatocellular carcinoma was admitted for scheduled transcatheter arterial chemoembolization therapy. He developed abdominal discomfort and nausea one day after the procedure. On examination, he had a distended abdomen, diffuse tenderness without rebound pain and reduced bowel sounds. He was afebrile, and results of blood tests were unremarkable. Plain abdominal radiography showed diffuse bowel loop dilation ( Figure 1A), and computed tomography showed marked bowel loop dilation and colonic gas, without obstructive masses or ischemic bowel lesions ( Figure 1B).We diagnosed acute pseudo-obstruction of the colon (Ogilvie syndrome). Nasogastric decompression and discontinuation of oral intake did not relieve our patient's abdominal pain. He developed dyspnea because of persistent abdominal distention, and we decided to use colonoscopic decompression followed by neostigmine. He recovered fully from the syndrome and received treatment for hepatocellular carcinoma.Ogilvie syndrome is marked by nonmechanical dilation of the cecum and right colon.1 It presents with abdominal pain and abnormal intestinal motility, and is not uncommon in patients with critical illnesses, electrolyte imbalances, anticholinergic medication regimens and recent surgery. In our patient, we believe the syndrome was related to transcatheter arterial chemoembolization therapy. The exact pathogenesis of the syndrome remains unclear, although imbalance of the autonomic nervous system affecting the colon has been proposed. Unlike toxic megacolon (often caused by inflammatory bowel disease or infection), Ogilvie syndrome usually does not present with signs of systemic toxicity. Computed tomography is usually indicated for ruling out obstructive lesions or possible bowel ischemia. If the syndrome is left untreated, life-threatening complications such as bowel ischemia or perforation may occur in an estimated 3%-15% of patients, with a 50% reported mortality rate.2 The success rate for nasogastric decompression with or without anal tube placement is variable (20%-92%), and colonoscopic decompression is successful in about 70% of patients.2 A resolution rate of 80%-90% has been reported for use of neostigmine (2.0 mg intravenously) when conservative therapy has failed.2 Surgical management with cecostomy or colectomy is reserved for refractory cases.This article has been peer reviewed.Competing interests: None declared.

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Acute colonic pseudo-obstruction

Cited by 111 publications

References 14 publications

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

Colonic Pseudo-Obstruction

Ogilvie syndrome: acute pseudo-obstruction of the colon

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