Acute Colonic Pseudoobstruction

Abstract

Acute colonic pseudoobstruction (ACPO), often referred to as Ogilvie syndrome, is a clinical entity characterized by severe colonic distension (adult acute megacolon) in the absence of mechanical obstruction. It can result in abdominal ischemia and perforation if left untreated. This article discusses the epidemiology and current pathophysiologic theories of ACPO as well as the clinical presentation and diagnostic modalities utilized to identify the disease. In addition, this article describes the current treatment options for ACPO, which range from conservative medical therapy, therapeutic endoscopy, to subtotal colectomy.

Keywords

colonic ileus - acute colonic pseudoobstruction - Ogilvie syndrome - large bowel obstruction

• References

• 1 Bode WE, Beart Jr RW, Spencer RJ, Culp CE, Wolff BG, Taylor BM. Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome). Report of 22 cases and review of the literature. Am J Surg 1984; 147 (2) 243-245
• 2 Wegener M, Börsch G. Acute colonic pseudo-obstruction (Ogilvie's syndrome). Presentation of 14 of our own cases and analysis of 1027 cases reported in the literature. Surg Endosc 1987; 1 (3) 169-174
• 3 Ogilvie H. Large-intestine colic due to sympathetic deprivation; a new clinical syndrome. BMJ 1948; 2 (4579) 671-673
• 4 Barrett KE. Chapter 9. Intestinal motility. In: Barrett KE, , eds. Gastrointestinal Physiology, 2nd ed. New York, NY: McGraw-Hill; 2014
• 5 Kimoto M, Zeredo JL, Ota MS, Nihei Z, Toda K. Comparison of stress-induced modulation of smooth-muscle activity between ileum and colon in male rats. Auton Neurosci 2014; 183: 8-11
• 6 Onori L, Aggio A, D'Alo' S , et al. Role of nitric oxide in the impairment of circular muscle contractility of distended, uninflamed mid-colon in TNBS-induced acute distal colitis in rats. World J Gastroenterol 2005; 11 (36) 5677-5684
• 7 Kodama Y, Iino S, Shigemasa Y, Suzuki H. Properties of acetylcholine-induced relaxation of smooth muscle isolated from the proximal colon of the guinea-pig. J Smooth Muscle Res 2010; 46 (4) 185-200
• 8 Norwood MG, Lykostratis H, Garcea G, Berry DP. Acute colonic pseudo-obstruction following major orthopaedic surgery. Colorectal Dis 2005; 7 (5) 496-499
• 9 Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum 1986; 29 (3) 203-210
• 10 Davis L, Lowman RM. An evaluation of cecal size in impending perforation of the cecum. Surg Gynecol Obstet 1956; 103 (6) 711-718
• 11 Choi JS, Lim JS, Kim H , et al. Colonic pseudoobstruction: CT findings. AJR Am J Roentgenol 2008; 190 (6) 1521-1526
• 12 Jacob SE, Lee SH, Hill J. The demise of the instant/unprepared contrast enema in large bowel obstruction. Colorectal Dis 2008; 10 (7) 729-731
• 13 Beck D. ASCRS Textbook of Colon and Rectal Surgery. 2nd ed. New York: Springer; 2011
• 14 Gordon P, Nivatvongs S. The Principles and Practice of Surgery for the Colon, Rectum, and Anus. 3rd ed. New York: CRC Press; 2007
• 15 Ponec RJ, Saunders MD, Kimmey MBN. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med 1999; 341 (3) 137-141
• 16 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
• 17 Trevisani GT, Hyman NH, Church JM. Neostigmine: safe and effective treatment for acute colonic pseudo-obstruction. Dis Colon Rectum 2000; 43 (5) 599-603
• 18 Tangsucharit P, Takatori S, Sun P , et al. Do cholinergic nerves innervating rat mesenteric arteries regulate vascular tone?. Am J Physiol Regul Integr Comp Physiol 2012; 303 (11) R1147-R1156
• 19 White L, Sandhu G. Continuous neostigmine infusion versus bolus neostigmine in refractory Ogilvie syndrome. Am J Emerg Med 2011; 29 (5) 576.e1-576.e3
• 20 Paran H, Silverberg D, Mayo A, Shwartz I, Neufeld D, Freund U. Treatment of acute colonic pseudo-obstruction with neostigmine. J Am Coll Surg 2000; 190 (3) 315-318
• 21 Turégano-Fuentes F, Muñoz-Jiménez F, Del Valle-Hernández E , et al. Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment. Dis Colon Rectum 1997; 40 (11) 1353-1357
• 22 Sgouros SN, Vlachogiannakos J, Vassiliadis K , et al. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut 2006; 55 (5) 638-642
• 23 Borgaonkar MR, Lumb B. Acute on chronic intestinal pseudoobstruction responds to neostigmine. Dig Dis Sci 2000; 45 (8) 1644-1647
• 24 Harig JM, Fumo DE, Loo FD , et al. Treatment of acute nontoxic megacolon during colonoscopy: tube placement versus simple decompression. Gastrointest Endosc 1988; 34 (1) 23-27
• 25 Harrison ME, Anderson MA, Appalaneni V , et al; ASGE Standards of Practice Committee. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71 (4) 669-679
• 26 Messmer JM, Wolper JC, Loewe CJ. Endoscopic-assisted tube placement for decompression of acute colonic pseudo-obstruction. Endoscopy 1984; 16 (4) 135-136
• 27 Stephenson KR, Rodriguez-Bigas MA. Decompression of the large intestine in Ogilvie's syndrome by a colonoscopically placed long intestinal tube. Surg Endosc 1994; 8 (2) 116-117
• 28 Groff W. Colonoscopic decompression and intubation of the cecum for Ogilvie's syndrome. Dis Colon Rectum 1983; 26 (8) 503-506
• 29 Rex DK. Acute colonic pseudo-obstruction (Ogilvie's syndrome). Gastroenterologist 1994; 2 (3) 233-238
• 30 Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc 1996; 44 (2) 144-150
• 31 Tsirline VB, Zemlyak AY, Avery MJ , et al. Colonoscopy is superior to neostigmine in the treatment of Ogilvie's syndrome. Am J Surg 2012; 204 (6) 849-855 , discussion 855
• 32 Nishiwaki S, Hatakeyama H, Takada J , et al. Transcecostomal colonic stent placement after US-guided percutaneous cecostomy. Gastrointest Endosc 2010; 71 (6) 1097-1099
• 33 Benacci JC, Wolff BG. Cecostomy. Therapeutic indications and results. Dis Colon Rectum 1995; 38 (5) 530-534
• 34 vanSonnenberg E, Varney RR, Casola G , et al. Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience. Radiology 1990; 175 (3) 679-682
• 35 Ramage Jr JI, Baron TH. Percutaneous endoscopic cecostomy: a case series. Gastrointest Endosc 2003; 57 (6) 752-755