Acute pseudo-obstruction of the colon (Ogilvie's syndrome)

Abstract

This study analyzes 400 cases of acute pseudo-obstruction of the colon (Ogilvie's syndrome). Seven cases were reported at St. Elizabeth Hospital Medical Center between October 1982 and February 1985; 393 cases were reported in the literature from 1970-1985. Ogilvie's syndrome is most commonly reported in patients in the sixth decade, and is more predominant in men. It is caused by an unknown disturbance to the autonomic innervation of the distal colon, and is associated with different conditions. Plain abdominal roentgenogram is the most useful diagnostic test. If the cecal diameter is 12 cm or greater, or conservative management is unsuccessful, colonoscopic or operative decompression is needed. The mode of treatment, age, cecal diameter, delay in decompression, and status of the bowel significantly influence the mortality rate, which is approximately 15 percent with early appropriate management, compared with 36 to 44 percent in perforated or ischemic bowel.

Distensão Abdominal Aguda em Paciente com Síndrome Consumptiva

“…A pseudo obstrução colônica aguda, também denominada Síndrome de Ogilvie, é caracterizada por uma intensa dilatação do ceco e do cólon direito, podendo ainda estender-se para o reto, sem que haja uma causa obstrutiva de natureza mecânica para explicar a parada do trânsito intestinal [1][2][3][4] . A patogênese exata da dilatação do colón é ainda desconhecida, porém acredita-se que resulte de um desequilíbrio entre sistema nervoso autônomo simpático e parassimpático 1 .…”

“…É importante ressaltar que a tomografia pode ainda detectar sinais de isquemia e perfurações, além de anormalidades em estruturas pericolônicas 2 . Os principais diagnósticos que devem ser incluídos como diagnósticos diferenciais são: Carcinoma, aderências, dilatação gástrica aguda, impactação fecal, volvo mesentérico, isquemias mesentéricas e megacólon chagásico 3 .…”

Constipação intestinal em terapia intensiva

“…(29) Its incidence is not well established in literature. It is an important cause of morbidity and mortality in ICU patients, (30)(31) and in presence of intestinal perforation, mortality can exceed 50%. (31) It is caused by imbalance of the autonomic activity with parasympathetic suppression and increased sympathetic activity.…”

“…Interruption of the autonomic nerves activity, from S2 to S4 leaves the distal colon sluggish and the proximal colon functioning. (30)(31)(32) This may be caused by electrolyte disturbances, mostly hypocalemia, hypocalcemia and hypomagnesemia. The clinical condition may be represented by: abdominal distention (100%), abdominal pain (80%) and nausea/ vomiting (60%).…”

“…There may be bowel sounds in 70% of cases. (30,33) Distension develops for 3 to 7 days, but can occur in less than 24 hours. (31) The differential diagnosis includes mechanical obstruction and megacolon due to Clostridium difficile.…”