Ogilvie's syndrome

Abstract

Forty-eight cases of Ogilvie's syndrome, colonic pseudo-obstruction, presenting between 1983 and 1989 were retrospectively reviewed to assess the results of colonoscopic decompression and to identify potential etiologic factors. Three patients had spontaneous resolution with medical treatment. Forty-five patients required 60 colonoscopic decompressions: 38 (84 percent) were successfully treated using colonoscopy; five (11 percent) required an operation; and two died within 48 hours of colonoscopy from medical causes. No complications or deaths were the result of colonoscopy. Twenty-nine patients (64 percent) were successfully treated with a single colonoscopy. One-third of patients required serial decompressions. Average cecal diameter in patients with successful colonoscopic decompression was 12.4 cm but was larger for patients requiring more than one colonoscopy (13.3 cm) and for those who failed colonoscopic therapy (13.4 cm). The spine or retroperitoneum had been traumatized or manipulated in 52 percent of patients. Patients with Ogilvie's syndrome were being treated with narcotics (56 percent), H-2 blockers (52 percent), phenothiazines (42 percent), calcium-channel blockers (27 percent), steroids (23 percent), tricyclic antidepressants (15 percent), and epidural analgesics (6 percent) at diagnosis. Electrolyte abnormalities included hypocalcemia (63 percent), hyponatremia (38 percent), hypokalemia (29 percent), hypomagnesemia (21 percent), and hypophosphatemia (19 percent). Colonoscopic decompression in Ogilvie's syndrome is safe and effective management. Multiple pharmacologic and metabolic factors, as well as spinal and retroperitoneal trauma, appear to alter autonomic regulation of colonic function, resulting in colonic pseudo-obstruction.

Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems

“…After exclusion of mechanical obstruction, intravenous neostigmine could be considered in patients with a caecal diameter >10 cm and without improvement within 24 h [29, 89] (grade 2B). Colonoscopy is recommended for non-surgical decompression in patients with a caecal diameter >10 cm and no improvement after 24–48 h of conservative treatment [29, 87, 90] (grade 1C). Colonoscopic decompression is effective in up to 80%, but carries a certain morbidity/mortality risk [30].…”

Syndrome d’Ogilvie post-césarienne : à propos d’une observation

“…La physiopathogénie du syndrome d'Ogilvie n'est pas parfaitement connue mais l'hypothèse principale est une anomalie de la régulation autonome de la motricité colique [1]. Un déséquilibre dans l'innervation autonome, sous l'influence de divers facteurs, conduit à une activité excessive du parasympathique.…”

“…Pour autant, d'après les différentes publications, l'origine de ce syndrome semble multifactorielle et survient dans des contextes autres que la période postopératoire [1,2]. Dans les études récentes, les terrains prédisposants sont les traumatismes, les infections et les pathologies cardiaques [3].…”

“…Le taux d'échec ou de récidive des symptômes est de plus de 30 % [1,3] ; mais la mise en place d'un drain en cours de procédure améliore ce taux. L'antibiothérapie systématique après ces gestes ne semble pas indiquée.…”

“…Le syndrome d'Ogilvie est caractérisé par une distension majeure du côlon (pouvant prédominer sur le segment droit notamment le caecum) en l'absence d'étiologie organique [1]. Ce diagnostic, rare en obstétrique, survient le plus souvent après une césarienne.…”