Clin Colon Rectal Surg 2021; 34(04): 242-250
DOI: 10.1055/s-0041-1727195
Review Article

Acute Colonic Pseudo-obstruction and Volvulus: Pathophysiology, Evaluation, and Treatment

Joshua Underhill
1   Department of General Surgery, Rush University Medical Center, Chicago, Illinois
,
Emily Munding
1   Department of General Surgery, Rush University Medical Center, Chicago, Illinois
,
Dana Hayden
1   Department of General Surgery, Rush University Medical Center, Chicago, Illinois
› Author Affiliations

Abstract

Acute colonic pseudo-obstruction (ACPO) and volvulus are two disease processes that affect the colon causing abdominal distension and may necessitate operation intervention. ACPO may be associated with multiple comorbidities, infectious diseases, and cardiac dysfunction. It may be treated with conservative management including endoscopic decompression or neostigmine. If the distension is not addressed, high mortality may result if peritonitis develops. Volvulus most commonly occurs in the sigmoid colon or cecum. If left-sided, endoscopic decompression may resolve the obstruction if detorsion is successful, although sigmoid colectomy should be performed during the admission. If cecal volvulus is identified, right hemicolectomy should be performed.



Publication History

Article published online:
20 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Ogilvie H. Large-intestine colic due to sympathetic deprivation; a new clinical syndrome. BMJ 1948; 2 (4579): 671-673
  • 2 Wells CI, O'Grady G, Bissett IP. Acute colonic pseudo-obstruction: a systematic review of aetiology and mechanisms. World J Gastroenterol 2017; 23 (30) 5634-5644
  • 3 Ross SW, Oommen B, Wormer BA. et al. Acute colonic pseudo-obstruction: Defining the epidemiology, treatment, and adverse outcomes of Ogilvie's syndrome. In: American Surgeon. Vol 82. Southeastern Surgical Congress; 2016: 102-111
  • 4 Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum 1986; 29 (03) 203-210
  • 5 De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg 2009; 96 (03) 229-239
  • 6 Jain A, Vargas HD. Advances and challenges in the management of acute colonic pseudo-obstruction (Ogilvie syndrome). Clin Colon Rectal Surg 2012; 25 (01) 37-45
  • 7 Bernardi MP, Warrier S, Lynch AC, Heriot AG. Acute and chronic pseudo-obstruction: a current update. ANZ J Surg 2015; 85 (10) 709-714
  • 8 Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther 2005; 22 (10) 917-925
  • 9 Durai R. Colonic pseudo-obstruction. Singapore Med J 2009; 50 (03) 237-244 http://www.ncbi.nlm.nih.gov/pubmed/19352564 Accessed March 03, 2021
  • 10 Dorudi S, Berry AR, Kettlewell MGW. Acute colonic pseudo-obstruction. Br J Surg 1992; 79 (02) 99-103
  • 11 Bachulis BL, Smith PE. Pseudoobstruction of the colon. Am J Surg 1978; 136 (01) 66-72
  • 12 Romeo DP, Solomon GD, Hover AR. Acute colonic pseudo-obstruction: a possible role for the colocolonic reflex. J Clin Gastroenterol 1985; 7 (03) 256-260
  • 13 De Giorgio R, Barbara G, Stanghellini V. et al. Review article: the pharmacological treatment of acute colonic pseudo-obstruction. Aliment Pharmacol Ther 2001; 15 (11) 1717-1727
  • 14 Dudley HA, Paterson-Brown S. Pseudo-obstruction. Br Med J (Clin Res Ed) 1986; 292 (6529): 1157-1158
  • 15 Sheikh RA, Yasmeen S, Pauly MP, Trudeau WL. Pseudomembranous colitis without diarrhea presenting clinically as acute intestinal pseudo-obstruction. J Gastroenterol 2001; 36 (09) 629-632
  • 16 Johnson CD, Rice RP, Kelvin FM, Foster WL, Williford ME. The radiologic evaluation of gross cecal distension: emphasis on cecal ileus. AJR Am J Roentgenol 1985; 145 (06) 1211-1217
  • 17 Chapman AH, McNamara M, Porter G. The acute contrast enema in suspected large bowel obstruction: value and technique. Clin Radiol 1992; 46 (04) 273-278
  • 18 Beattie GC, Peters RT, Guy S, Mendelson RM. Computed tomography in the assessment of suspected large bowel obstruction. ANZ J Surg 2007; 77 (03) 160-165
  • 19 Choi JS, Lim JS, Kim H. et al. Colonic pseudoobstruction: CT findings. AJR Am J Roentgenol 2008; 190 (06) 1521-1526
  • 20 Mehta R, John A, Nair P. et al. Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo-obstruction: a prospective study. J Gastroenterol Hepatol 2006; 21 (02) 459-461
  • 21 Davis L, Lowman RM. An evaluation of cecal size in impending perforation of the cecum. Surg Gynecol Obstet 1956; 103 (06) 711-718
  • 22 Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med 1999; 341 (03) 137-141
  • 23 Abeyta BJ, Albrecht RM, Schermer CR. Retrospective study of neostigmine for the treatment of acute colonic pseudo-obstruction. Am Surg 2001; 67 (03) 265-268 , discussion 268–269
  • 24 Amaro R, Rogers AI. Neostigmine infusion: new standard of care for acute colonic pseudo-obstruction?. Am J Gastroenterol 2000; 95 (01) 304-305
  • 25 Jetmore AB, Timmcke AE, Gathright Jr JB, Hicks TC, Ray JE, Baker JW. Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors. Dis Colon Rectum 1992; 35 (12) 1135-1142
  • 26 Fausel CS, Goff JS. Nonoperative management of acute idiopathic colonic pseudo-obstruction (Ogilvie's syndrome). West J Med 1985; 143 (01) 50-54
  • 27 Kukora JS, Dent TL. Colonoscopic decompression of massive nonobstructive cecal dilation. Arch Surg 1977; 112 (04) 512-517
  • 28 Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc 1996; 44 (02) 144-150
  • 29 Vantrappen G. Acute colonic pseudo-obstruction. Lancet 1993; 341 (8838): 152-153
  • 30 Maloney N, Vargas HD. Acute intestinal pseudo-obstruction (Ogilvie's syndrome). Clin Colon Rectal Surg 2005; 18 (02) 96-101
  • 31 Benacci JC, Wolff BG. Cecostomy. Therapeutic indications and results. Dis Colon Rectum 1995; 38 (05) 530-534
  • 32 Rex DK. Acute colonic pseudo-obstruction (Ogilvie's syndrome). Gastroenterologist 1994; 2 (03) 233-238
  • 33 Duh QY, Way LW. Diagnostic laparoscopy and laparoscopic cecostomy for colonic pseudo-obstruction. Dis Colon Rectum 1993; 36 (01) 65-70
  • 34 Ramage Jr JI, Baron TH. Percutaneous endoscopic cecostomy: a case series. Gastrointest Endosc 2003; 57 (06) 752-755
  • 35 Tenofsky PL, Beamer L, Smith RS. Ogilvie syndrome as a postoperative complication. Arch Surg 2000; 135 (06) 682-686 , discussion 686–687
  • 36 Halabi WJ, Jafari MD, Kang CY. et al. Colonic volvulus in the United States: trends, outcomes, and predictors of mortality. Ann Surg 2014; 259 (02) 293-301
  • 37 Holder Jr WD. Intestinal obstruction. Gastroenterol Clin North Am 1988; 17 (02) 317-340
  • 38 Oren D, Atamanalp SS, Aydinli B. et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 2007; 50 (04) 489-497
  • 39 Madiba TE, Aldous C, Haffajee MR. The morphology of the foetal sigmoid colon in the African population: a possible predisposition to sigmoid volvulus. Colorectal Dis 2015; 17 (12) 1114-1120
  • 40 Michael SA, Rabi S. Morphology of sigmoid colon in South Indian population: a cadaveric study. J Clin Diagn Res 2015; 9 (08) AC04-AC07
  • 41 Friedman JD, Odland MD, Bubrick MP. Experience with colonic volvulus. Dis Colon Rectum 1989; 32 (05) 409-416
  • 42 Sarioğlu A, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Colonic volvulus: a rare presentation of Hirschsprung's disease. J Pediatr Surg 1997; 32 (01) 117-118
  • 43 Ballantyne GH, Brandner MD, Beart Jr RW, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg 1985; 202 (01) 83-92
  • 44 Rabinovici R, Simansky DA, Kaplan O, Mavor E, Manny J. Cecal volvulus. Dis Colon Rectum 1990; 33 (09) 765-769
  • 45 Tejler G, Jiborn H. Volvulus of the cecum. Report of 26 cases and review of the literature. Dis Colon Rectum 1988; 31 (06) 445-449
  • 46 Radin DR, Halls JM. Cecal volvulus: a complication of colonoscopy. Gastrointest Radiol 1986; 11 (01) 110-111
  • 47 Peoples JB, McCafferty JC, Scher KS. Operative therapy for sigmoid volvulus. Identification of risk factors affecting outcome. Dis Colon Rectum 1990; 33 (08) 643-646
  • 48 Perret RS, Kunberger LE. Case 4: cecal volvulus. AJR Am J Roentgenol 1998; 171 (03) 855-859 , 860
  • 49 Udezue NO. Sigmoid volvulus in Kaduna, Nigeria. Dis Colon Rectum 1990; 33 (08) 647-649
  • 50 Schagen van Leeuwen JH. Sigmoid volvulus in a West African population. Dis Colon Rectum 1985; 28 (10) 712-716
  • 51 Astini C, Falaschi CF, Mariam M, Desta A. The management of sigmoid volvulus: report of 39 cases. Ital J Surg Sci 1988; 18 (02) 127-129
  • 52 Saidi F. The high incidence of intestinal volvulus in Iran. Gut 1969; 10 (10) 838-841
  • 53 Asbun HJ, Castellanos H, Balderrama B. et al. Sigmoid volvulus in the high altitude of the Andes. Review of 230 cases. Dis Colon Rectum 1992; 35 (04) 350-353
  • 54 Gama AH, Haddad J, Simonsen O. et al. Volvulus of the sigmoid colon in Brazil: a report of 230 cases. Dis Colon Rectum 1976; 19 (04) 314-320
  • 55 De U. Sigmoid volvulus in rural Bengal. Trop Doct 2002; 32 (02) 80-82
  • 56 Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rectal Surg 2012; 25 (04) 236-244
  • 57 Hussein HA, Bani-Hani KE, Rabadi DK. et al. Sigmoid volvulus in the Middle East. World J Surg 2008; 32 (03) 459-464
  • 58 Segal I. The effects of westernisation on sigmoid volvulus. Trop Gastroenterol 1985; 6 (01) 4-9
  • 59 Anderson JR, Welch GH. Acute volvulus of the right colon: an analysis of 69 patients. World J Surg 1986; 10 (02) 336-342
  • 60 Krupsky S, Halevy A, Orda R. Sigmoid volvulus in adolescence. J Clin Gastroenterol 1987; 9 (04) 467-469
  • 61 Peterson CM, Anderson JS, Hara AK, Carenza JW, Menias CO. Volvulus of the gastrointestinal tract: appearances at multimodality imaging. Radiographics 2009; 29 (05) 1281-1293
  • 62 Freeny PC, Stevenson GW. Margulis and Burhenne's Alimentary Tract Radiology. 5th edition. St. Louis, Mo: Mosby-Year Book; 1994: 362-365 , 2059–2061
  • 63 Catalano O. Computed tomographic appearance of sigmoid volvulus. Abdom Imaging 1996; 21 (04) 314-317
  • 64 Frank AJ, Goffner LB, Fruauff AA, Losada RA. Cecal volvulus: the CT whirl sign. Abdom Imaging 1993; 18 (03) 288-289
  • 65 Delabrousse E, Sarliève P, Sailley N, Aubry S, Kastler BA. Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol 2007; 14 (06) 411-415
  • 66 Field S. Alimentary Tract Radiology. 5th edition. vol. 1. St. Louis: Mosby; 1994: 2061-2062
  • 67 Brothers TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg 1987; 206 (01) 1-4
  • 68 Tan KK, Chong CS, Sim R. Management of acute sigmoid volvulus: an institution's experience over 9 years. World J Surg 2010; 34 (08) 1943-1948
  • 69 Bak MP, Boley SJ. Sigmoid volvulus in elderly patients. Am J Surg 1986; 151 (01) 71-75
  • 70 Kasten KR, Marcello PW, Roberts PL. et al. What are the results of colonic volvulus surgery?. Dis Colon Rectum 2015; 58 (05) 502-507
  • 71 Swenson BR, Kwaan MR, Burkart NE. et al. Colonic volvulus: presentation and management in metropolitan Minnesota, United States. Dis Colon Rectum 2012; 55 (04) 444-449
  • 72 Liang JT, Lai HS, Lee PH. Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus. Surg Endosc 2006; 20 (11) 1772-1773
  • 73 Anderson JR, Spence RA, Wilson BG, Hanna WA. Gangrenous caecal volvulus after colonoscopy. Br Med J (Clin Res Ed) 1983; 286 (6363): 439-440
  • 74 Påhlman L, Enblad P, Rudberg C, Krog M. Volvulus of the colon. A review of 93 cases and current aspects of treatment. Acta Chir Scand 1989; 155 (01) 53-56
  • 75 Madiba TE, Thomson SR. The management of cecal volvulus. Dis Colon Rectum 2002; 45 (02) 264-267