Ogilvie's syndrome after pediatric spinal deformity surgery: successful treatment with neostigmine

Abstract

<jats:p>Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus. Also known as acute colonic pseudo-obstruction, early recognition and diagnosis of the syndrome allows for treatment prior to bowel perforation and requisite abdominal surgery. The authors report a case of Ogilvie's syndrome following spinal deformity correction and tethered cord release in an adolescent who presented with acute abdominal distension, nausea, and vomiting on postoperative Day 0. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. This case is the first reported instance of neostigmine use for Ogilvie's syndrome treatment following a pediatric neurosurgical operation.</jats:p>

Ogilvie syndrome in a 8 year old girl after laparoscopic appendectomy

“…It occurs primarily in adult patients, whereas it happens rarely in children. It has been suggested that it could be the result of suppression of sacral parasympathetic nerves’ activity together with an increase in sympathetic impulses, resulting in inhibition of colonic motility and hence in colonic dilatation [5, 6, 10]. Other pathogenetic theories include prostaglandin E abnormalities, decreased splanchnic perfusion, side effects of neurotropic medications, metabolic disorders affecting neuromuscular conduction (hypokalaemia, uremia) and herpes zoster virus reactivation [10].…”

“…Other pathogenetic theories include prostaglandin E abnormalities, decreased splanchnic perfusion, side effects of neurotropic medications, metabolic disorders affecting neuromuscular conduction (hypokalaemia, uremia) and herpes zoster virus reactivation [10]. Patients present with recurrent vomiting, nausea, abdominal pain and prominent abdominal distension [6].…”

“…Ogilvie’s syndrome is a rare complication mostly described in adult patients with severe underlying medical or surgical conditions [1]. However, an increased number of cases of Ogilvie’s syndrome has been reported in children with oncological diseases [2–5], after spinal surgery [6], in sickle cell and Kawasaky disease [7, 8], and after renal transplant [9].…”

Wilkie or Ogilvie?

“…The colonic dilatation, which is accompanied by intermittent flatus change and lack of bowel sounds, is relieved by colonoscopic decompression, water soluble contrast administered orally or rectally, naso-gastric aspiration, enema, neostigmine, or operation. Ogilvie's syndrome was described following spinal deformity correction and tethered cord release in an adolescent who presented with acute abdominal distension, nausea, and vomiting on postoperative first day [18]. This case is the first reported instance of neostigmine use for Ogilvie's syndrome treatment following a pediatric neurosurgical operation.…”

Limitations and complications of minimally invasive spinal surgery in adult deformity

“…OS is clinically diagnosed as diminished gastric motility that does not resolve on its own in a matter of days. Radiographically it is characterized by dilatation of cecum greater than 9 cm and lack of mechanical obstruction on abdominal CT. Neostigmine, a acetylcholinesterase inhibitor, is rarely used in treating OS if more conservative measures fail (40,42).…”