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Pedroza Pinheiro R, Ribeiro Nascimento L, Rodrigo Tavares Costa H, Luiz Aparecido Defino H. OGILVIE SYNDROME FOLLOWING SPINAL SURGERY. SANAMED 2022. [DOI: 10.24125/sanamed.v16i3.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Chen CJ, Shah AA, Hsiue PP, Subhash AK, Lord EL, Park DY, Stavrakis AI. Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) After Primary Spinal Fusion: An Analysis of Outcomes and Risk Factors from 2005 to 2014. World Neurosurg 2021; 155:e612-e620. [PMID: 34481105 DOI: 10.1016/j.wneu.2021.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ogilvie syndrome (OS) is a rare but serious condition seen in the postoperative period. This was an epidemiologic study using data from the National Inpatient Sample from 2005 to 2014 to look at incidence, risk factors, and outcomes associated with OS after primary spine fusion. METHODS International Classification of Diseases, Ninth Revision codes were used to identify patients who underwent spine fusion surgery. Patients were separated into 2 cohorts based on the diagnosis of OS. Outcome measures and risk factors for cohorts were analyzed using multivariate logistic regression and compared. RESULTS Over the 10-year study period, 3,884,395 patients underwent primary spine fusion surgery. Among these, 0.04% developed OS during the index hospitalization. The greatest incidence seen in primary fusion involved the thoracic spine (0.15%). OS was more common after spine fusion for spine deformity (P < 0.001). Patients with OS were more likely to be men (P < 0.001), older (P < 0.0001), and have more comorbidities (P < 0.0001). Patients with OS were more likely to require postoperative blood transfusions (odds ratio [OR], 3.39; 95% confidence interval [CI], 2.51-4.59; P < 0.001) and sustain any complication (OR, 4.20; 95% CI, 3.17-5.57; P < 0.001). Patients with OS had a longer length of stay (15.7 vs. 3.9 days; P < 0.001) and increased average hospitalization cost ($63,037.03 vs. $26,792.19; P < 0.001). The development of OS was associated with fluid electrolyte disorder (OR, 4.06; 95% CI, 2.99-5.51; P < 0.001). CONCLUSIONS OS is a rare but serious complication of primary spine fusion surgery. Identifying the specific risk factors, symptoms, and potential complications related to OS is critical to aid in decreasing the significant morbidity associated with its development.
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Affiliation(s)
- Clark J Chen
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
| | - Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Ajith K Subhash
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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Ahmad MU, Riley KD, Ridder TS. Acute Colonic Pseudo-Obstruction After Posterior Spinal Fusion: A Case Report and Literature Review. World Neurosurg 2020; 142:352-363. [PMID: 32659357 DOI: 10.1016/j.wneu.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) or Ogilvie's syndrome occurs in 0.22%-7% of patients undergoing surgery, with a mortality of up to 46%. ACPO increased median hospital days versus control in spinal surgery (14 vs. 6 days; P < 0.001). If defined as postoperative ileus, the incidence was 7%-13.4%. Postoperative ileus is associated with 2.9 additional hospital days and an $80,000 increase in cost per patient. We present a case of ACPO in an adult patient undergoing spinal fusion for correction of scoliosis and review the available literature to outline clinical characteristics and surgical outcomes. CASE DESCRIPTION The patient was a 31-year-old woman with untreated advanced scoliosis with no history of neurologic issues. T2-L3 spinal instrumentation and fusion was completed. Plain abdominal radiography showed of dilated cecum 11 cm and the department of general surgery was consulted. Neostigmine administration was planned after conservative treatment failure after transfer to the intensive care unit. The patient was discharged home with no recurrence >60 days. Thirty cases were found in our literature review using PubMed and Embase databases and summarized. CONCLUSIONS Of 30 cases reviewed, only 3 cases of ACPO were specific to patients undergoing spinal fusion for scoliosis. According to the literature, 20% of patients had resolution with conservative treatment, 40% with neostigmine, and 30% with surgical intervention. Other noninvasive treatments may have similar efficacy in preventing complications leading to surgical invention. Sixty clinical trials and 9 systematic reviews were summarized with an updated management algorithm.
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Affiliation(s)
- M Usman Ahmad
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Keyan D Riley
- Trauma and Acute Care Surgery, Memorial Hospital, University of Colorado Health, Colorado Springs, Colorado, USA
| | - Thomas S Ridder
- Pediatric and Adult Neurosurgery, UCHealth Brain & Spine Clinic, Children's Hospital of Colorado, Colorado Springs, Colorado, USA
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Januszewski J, Keem SK, Smith W, Beckman JM, Kanter AS, Oskuian RJ, Taylor W, Uribe JS. The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients. World Neurosurg 2016; 99:302-307. [PMID: 27923757 DOI: 10.1016/j.wneu.2016.11.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies. METHODS Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded. RESULTS Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy. CONCLUSION Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair.
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Affiliation(s)
- Jacob Januszewski
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
| | - Sean K Keem
- Department of Orthopedics-Spine Surgery, The Polyclinic, Seattle, Washington, USA
| | - William Smith
- Department of Neurosurgery, University Medical Center Las Vegas, Las Vegas, Nevada, USA
| | - Joshua M Beckman
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburg Medical Center, Wexford, Pennsylvania, USA
| | - Rod J Oskuian
- Department of Neurosurgery, Swedish Medical Center, Seattle, Washington, USA
| | - William Taylor
- Division of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Juan S Uribe
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
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Krishnakumar R, Kuzhimattam MJ, Kumar G. Ogilvie's syndrome following posterior spinal instrumentation in thoraco lumbar trauma. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:179-82. [PMID: 26692695 PMCID: PMC4660494 DOI: 10.4103/0974-8237.167866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: To report unique cases of Ogilvie's syndrome (acute intestinal pseudo-obstruction) following posterior spinal instrumentation in thoraco lumbar trauma. Materials and Methods: A single centre retrospective study. We reviewed the surgical data of 420 patients who underwent thoracolumbar spinal surgery over a period of four years. Two patients who developed post operative Ogilvie's syndromes were identified. Results: The clinical presentation and blood investigations ruled out any infectious pathology. Computed tomography scans ruled out the mechanical obstruction. All patients improved with conservative management. Conclusion: Ogilvie's syndrome should be considered as a differential diagnosis in patients with postoperative significant abdominal distension who had undergone posterior instrumentation for spinal trauma. Early recognition and appropriate conservative treatment would be necessary to prevent complications such as bowel ischemia and perforation.
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Affiliation(s)
- R Krishnakumar
- Department of Orthopaedics, Spine Division, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Mathew John Kuzhimattam
- Department of Orthopaedics, Spine Division, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Gaurav Kumar
- Department of Orthopaedics, Spine Division, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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Hooten KG, Oliveria SF, Larson SD, Pincus DW. Ogilvie's syndrome after pediatric spinal deformity surgery: successful treatment with neostigmine. J Neurosurg Pediatr 2014; 14:255-8. [PMID: 25036854 DOI: 10.3171/2014.6.peds13636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Abstract
We report Ogilvie's syndrome following posterior spinal arthrodesis on a patient with thoracic and lumbar scoliosis associated with intraspinal anomalies. Postoperative paralytic ileus can commonly complicate scoliosis surgery. Ogilvie's syndrome as a cause of abdominal distension and pain has not been reported following spinal deformity correction and can mimic post-surgical ileus. 12 year old female patient with double thoracic and lumbar scoliosis associated with Arnold-Chiari 1 malformation and syringomyelia. The patient underwent posterior spinal fusion from T4 to L3 with segmental pedicle screw instrumentation and autogenous iliac crest grafting. She developed abdominal distension and pain postoperatively and this deteriorated despite conservative management. Repeat ultrasounds and abdominal computer tomography scans ruled out mechanical obstruction. The clinical presentation and blood parameters excluded toxic megacolon and cecal volvulus. As the symptoms persisted, a laparotomy was performed on postoperative day 16, which demonstrated ragged tears of the colon and cecum. A right hemi-colectomy followed by ileocecal anastomosis was required. The pathological examination of surgical specimens excluded inflammatory bowel disease and vascular abnormalities. The patient made a good recovery following bowel surgery and at latest followup 3.2 years later she had no abdominal complaints and an excellent scoliosis correction. Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after scoliosis correction. Early diagnosis and instigation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.
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Affiliation(s)
- Athanasios I Tsirikos
- Consultant Orthopaedic and Spine Surgeon, Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh, EH9 1LF, UK,Address for correspondence: Mr. Athanasios I. Tsirikos, Consultant Orthopaedic and Spine Surgeon, Honorary Clinical Senior Lecturer-University of Edinburgh, Scottish National Spine Deformity Center, Sciennes Road, Edinburgh, EH9 1LF, UK. E-mail:
| | - Alok Sud
- Commonwealth Travelling Spinal Fellow, Scottish National Spine Deformity Center, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK
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Abstract
OBJECTIVE Acute colonic pseudo-obstruction (ACPO) has been linked with multiple aetiologies including orthopaedic surgery. However, the actual incidence and natural progression are not well described in these patients. We aim to assess the incidence of ACPO in patients undergoing elective orthopaedic procedures, and to examine for potential exacerbating factors. PATIENTS AND METHODS All patients from the orthopaedic directorate that had abdominal imaging in the five years from August 1998 to August 2003 were identified from radiology archives. A manual search of the patients' notes was conducted with data recorded on the patients' history, operative details and their postoperative course including their haematological and biochemical results. Details regarding their ACPO were documented with respect to the onset of symptoms, how the diagnosis was achieved, what treatment was instigated and how the condition progressed. A control group of age and sex matched patients was included for comparison. RESULTS Thirty-five patients with ACPO were identified. The operations included 21 hip replacements, 10 knee replacements and 4 spinal operations. The incidence of ACPO was 1.3%, 0.65% and 1.19%, respectively. In comparison to control patients, patients with ACPO had a lower postoperative serum sodium (P = 0.001), a higher serum urea (P = 0.021) and remained in hospital longer (P < 0.001). CONCLUSION ACPO is uncommon in orthopaedic patients, however, its occurrence results in prolonged hospital stay. Attention to patients' postoperative fluid balance and biochemical status may reduce the incidence.
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Affiliation(s)
- M G A Norwood
- Department of Surgery, University of Leicester, Leicester, UK.
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Abstract
The gastroenterologist is frequently involved in the care of patients with bowel obstruction and pseudo-obstruction. In the case of obstruction, the central problem is determining which patients should be managed surgically. In both SBO and LBO, evidence of vascular compromise to the gut mandates surgical intervention. Most patients with pseudo-obstruction respond to conservative therapy or neostigmine. Endoscopic decompression is indicated in recalcitrant cases, with surgery reserved as a last resort.
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Affiliation(s)
- Charles J Kahi
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202-5121, USA
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