Ogilvie's Syndrome.pdf - Henry Ford Health System

Abdominal XrayMarked dilation ofcolonMaximal diameter of12 cmNo obvious free air

CTAxial ViewMassivecolon dilationAlso noted:Small bowelloops ofnormalcaliber

CTDilatedlarge bowelloopsLargeamount ofstool inrectumStool 9 cmat greatestdiameter

CTRectalstool ball

Barium EnemaGastrografin contrastreached midascending colonCecum not distinctlyidentifiedRenal contrast seenin collecting systemand bladder fromrecent CT scan

Differential Diagnosis• Colonic obstruction• Colonic volvulus – cecal or sigmoid• Colorectal carcinoma• Ogilvie syndrome• Ileus – postoperative or paralytic

Diagnosis - Ogilvie syndrome• Patient has a history of multiple sclerosisconsistent with Ogilvie syndrome• Colonic dilation unchanged past 2 yrs• Ogilvie syndrome is also known as acute colonicpseudo-obstruction obstruction (ACPO)• Radiological appearance of acute large bowelobstruction without a mechanical cause• Hallmark - massive cecal dilation• Cecal ischemia and perforation can occur

Discussion - Ogilvie syndrome• Described by British surgeon Sir Ogilvie in 1948• Usually hospitalized patients• Often a recent medical illness or surgical procedure• Also seen in trauma and neurological conditions• Pathophysiology: : Imbalance in the autonomicinnervation of the colon• Decrease in parasymathetic activity leading toadynamic colon similar to Hirschsprung Disease(normal ganglion cells at autopsy)• Increase in sympathetic activity

Discussion cont.• Radiology:• Abdominal x-ray x- dilated cecum ( > 10 cm) and diffuse colonicdilation (ascending & transverse)• Important to rule out mechanical obstruction• Gas shadows in rectum on plain film• Normal colonic filling on radiographic enema• Important to rule out volvulus• Ogilvie syndrome treatments:• Enemas, NG suction, stop mobility impairing medication• Neostigmine – inhibits acetyl cholinesterase → increasedacetylcholine → increased GI motility• Colonoscopic decompression (cecal(recurrence 22-41%), tubececostomy (open or CT guided), subtotal colectomy (ifperforated)

References• Remy, MD, et al. “OlilvieSyndrome.” eMedicine Specialties:Gastroenterology: Colon. (2008)• N. Agarwal, , A. Mishra & Z. Kayali : Acute Colonic Pseudo-obstruction (The Ogilvie syndrome): A Case Report and Review ofLiterature . The Internet Journal of Emergency and Intensive CareMedicine. 2003 Volume 7 Number 1