Ogilvie's syndrome: management and outcomes

A Case of Acute Colonic Pseudo-Obstruction and Anastomotic Leakage After Sigmoidectomy for Sigmoid Volvulus

Acute colonic pseudo-obstruction (ACPO) is characterized by significant colonic distension without a mechanical obstruction. We present a case of an 83-year-old male who developed ACPO following laparoscopic surgery for sigmoid volvulus. This report details the patient's postoperative journey, highlighting the diagnostic and management challenges encountered. Despite various medical interventions, the patient's condition necessitated further surgical attention due to complications. This case underscores the importance of early diagnosis and aggressive management in ACPO to prevent life-threatening consequences and improve patient outcomes.

Ogilvie's Syndrome in a Young Female With Chronic Constipation

Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, is often encountered in post-surgical patients or those with serious comorbidities requiring intensive care. For this reason, it has rarely been reported in patients younger than 50 years without any predisposing risk factors. Our case report highlights a unique case of Ogilvie's syndrome in a young female with no recent trauma or surgical history. To that extent, we discuss risk factors that predisposed her to this condition, including her history of chronic constipation. We also emphasize the need for outpatient workups for such patients to prevent the worsening of their symptoms.

Mortality Due to Complications Associated With Acute Ogilvie's Syndrome in an Older Adult Treated for Psychosis: A Case Report

Acute colonic pseudo-obstruction or Ogilvie's syndrome is a disorder causing massive colonic dilation with no evidence of mechanical obstruction. The actual incidence of acute colonic pseudo-obstruction is unclear; However, electrolyte imbalance, psychiatric disorders, the use of medications such as anticholinergics or antipsychotics, and recent abdominal surgery are the most common predisposing factors associated with this syndrome. Ogilvie's syndrome is most likely caused due to impairment of the gut's motor system and an imbalance of the autonomic nervous system including a reduction in the activity of stimulatory neurotransmitters. The predisposition to psychotic disorders could be, in some instances, due to neurodevelopmental abnormalities of the brain and the gut's autonomic nervous system. The symptoms of Ogilvie's syndrome are similar to mechanical obstruction of the colon but no physical cause of obstruction is usually present. Ogilvie's syndrome can be managed conservatively; however, if left untreated, Ogilvie's syndrome can lead to bowel perforation, which is associated with a high mortality risk. Antipsychotics have been considered the cornerstone treatment for psychiatric disorders including schizophrenia. Even though they are highly effective in treating psychiatric illnesses, their usage carries multiple risks. Overall, constipation is a common side effect of antipsychotic medications with some classes posing more risk than others. Constipation can be severe and may lead to serious complications such as paralytic ileus, bowel ischemia, and death. We present here a case of delusional disorder managed with risperidone and complicated by intestinal pseudo-obstruction. This case reiterates the need to consider all complications of antipsychotic medications, even rare ones, and include them in the discussion with patients and their caregivers before commencement.

A Novel Technique Using Ryle's Tube for Colonic Decompression in Acute Colonic Pseudo-Obstruction

Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, involves colon dilation without mechanical obstruction. It is conventionally treated with conservative measures such as fasting, nasogastric and rectal tube placement, correction of fluids and electrolytes, and, if necessary, use of neostigmine and colonic decompression through colonoscopy. Surgical intervention may be considered in severe cases. In this report, we present a case of acute colonic pseudo-obstruction where initial conservative management failed. The patient was successfully treated using a novel rectal tube insertion technique.

Comparison between abdominal CT findings in intensive care unit (ICU) and non-ICU patients with Covid-19: experience from a tertiary care hospital

Background

16-66% of COVID-19 positive patients may have abdominal symptoms and findings in abdominal CT. The yield of abdominal CT scan in patients having abdominal complaints is not known.

Objectives

The aim of this study was to explore the various abdominal imaging manifestations of COVID-19 and COVID-19 associated Mucormycosis (CAM) and to identify the relevant clinical and laboratory features associated with severity of the symptoms.

Methods

A retrospective single centre observational study was performed at a tertiary care hospital in Northwest India. All consecutive patients who had COVID positive RT-PCR report and had undergone abdominal Computed Tomography scan from March 2020 to November 2021 for various abdominal complaints were included. Demographic data, CT images and reports and all relevant lab parameters were collected.

Results

Out of 75 patients, positive abdominal findings were seen in 65 patients. Hepatobiliary findings were seen in 41.3% (31 of 75; OR=1.9) and bowel abnormalities were found in 37.3% (28 of 75; OR=2.1) of COVID-19 patients. 7 patients who had renal infarcts or bowel ischemia were found to have COVID-19 associated Mucormycosis on histopathology.

Conclusion

Chest CT severity score was positively correlated with most of the abdominal manifestations in patients requiring ICU admission. Elevated D-dimer levels were significantly associated with abdominal symptoms.

Ogilvie's Syndrome in a Patient at 23 Weeks of Pregnancy: Report of a Rare Case with Successful Surgical Intervention

BACKGROUND Ogilvie's syndrome (acute colonic pseudo-obstruction) is a syndrome characterized by symptoms suggestive of intestinal obstruction without an identifiable mechanical cause. It presents with excessive dilation of the loops of the large intestine. The treatment options include conservative management, endoscopic methods, and surgical intervention. If appropriate treatment is not implemented promptly, this syndrome can lead to life-threatening complications for the patient. Acute colonic pseudo-obstruction typically occurs in elderly individuals with numerous chronic diseases, extensive surgeries, or trauma. In younger individuals, risk factors include gynecological procedures, pregnancy, and childbirth. CASE REPORT This work presents a case of a 30-year-old woman at 23 weeks of pregnancy. She presented with persistent abdominal pain, nausea, and vomiting for several days. The patient was initially treated at the Obstetrics Clinic, where conservative management was implemented. Due to worsening symptoms after confirming pathological distension of the colon in the magnetic resonance imaging examination, she was transferred to the surgery clinic. Due to her unstable general condition and lack of improvement with conservative treatment, she was qualified for an appendectomy with the formation of a cecostomy. The performed surgical treatment led to an improvement in the patient's condition and did not have a negative impact on the further development of the child. CONCLUSIONS Ogilvie's syndrome in pregnancy is an extremely rare condition that can lead to significant complications. Its treatment requires the coordinated efforts of a multidisciplinary team of specialists. During the course of therapy, it is important to consider the limitations imposed by pregnancy on diagnostic and therapeutic methods.

Acute Colonic Pseudo-Obstruction in an Elderly Female Patient With Chronic Constipation

Acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is an acute colonic dilatation without mechanical obstruction; it is most commonly seen in severely ill or postoperative patients. While this syndrome has no clear pathophysiology, it is diagnosed when the cecum and right colon expand without physical obstruction. This condition can lead to perforation and intestinal ischemia. Ogilvie's syndrome is associated with a relatively high morbidity and mortality rate. The diagnosis of ACPO can be often missed due to its vague symptoms such as bloating, abdominal distention, abdominal pain, nausea and vomiting, and severe constipation. We report the case of an 82-year-old female patient who had a unique diagnosis of ACPO, or Ogilvie's syndrome, overshadowed by the diagnosis of severe constipation. This case highlights the importance of maintaining a high index of suspicion and early diagnosis of symptoms that can rapidly become dangerous.

Acute colonic pseudo-obstruction syndrome in patients with severe COVID-19 in Buenos Aires, Argentina

BACKGROUND

Several gastrointestinal complications have been reported in patients with COVID-19, including motility disorders, such as acute colonic pseudo-obstruction (ACPO). This affection is characterized by colonic distention in the absence of mechanical obstruction. ACPO in the context of severe COVID-19 may be related to neurotropism and direct damage of SARS-CoV-2 in enterocytes.

METHOD

We conducted a retrospective study of patients who were hospitalized for critical COVID-19 and developed ACPO between March 2020 and September 2021. The diagnostic criteria to define ACPO was the presence of 2 or more of the following: abdominal distension, abdominal pain, and changes in the bowel movements, associated with distension of the colon in computed tomography. Data of sex, age, past medical history, treatment, and outcomes were collected.

RESULTS

Five patients were detected. All required admission to the Intensive Care Unit. The ACPO syndrome developed with a mean of 33.8 days from the onset of symptoms. The mean duration of the ACPO syndrome was 24.6 days. The treatment included colonic decompression with placement of rectal and nasogastric tubes, endoscopy decompression in two patients, bowel rest, fluid, and electrolytes replacement. One patient died. The remaining resolved the gastrointestinal symptoms without surgery.

CONCLUSIONS

ACPO is an infrequent complication in patients with COVID-19. It occurs especially in patients with critical condition, who require prolonged stays in intensive care and multiple pharmacological treatments. It is important to recognize its presence early and thus establish an appropriate treatment, since the risk of complications is high.

A Challenge Called Ogilvie´s Syndrome

Ogilvie´s syndrome is a colonic dilation without any existing mechanical obstruction. The risk factors that cause it are not completely understood, but if untreated, the distension can result in rupture or ischaemic bowel perforation. Additionally, the existing guidelines do not agree with each other about the next steps if conservative treatment fails. We report the case of a 71-year-old woman in whom Ogilvie´s syndrome was particularly difficult to manage, and with it, we try to add clinical data to a field with scarce evidence.

Ogilvie Syndrome in Patients With Traumatic Pelvic and/or Acetabular Fractures: A Retrospective Cohort Study

OBJECTIVES

To assess the incidence, risk factors, and clinical outcomes of Ogilvie syndrome (OS) in patients with pelvic and/or acetabular fractures.

DESIGN

Retrospective cohort study.

SETTING

Level 1 trauma center.

PATIENTS

One thousand sixty patients with pelvic and/or acetabular fractures treated at Rigshospitalet, Copenhagen, between 2009 and 2020.

INTERVENTION

Interventions comprised the treatment of pelvic and/or acetabular fractures with emergency external and/or internal fixation.

MAIN OUTCOME MEASUREMENTS

Outcomes included diagnosis of OS, perioperative complications, ICU stay and length, length of admission, and mortality.

RESULTS

We identified 1060 patients with pelvic and/or acetabular fractures. Of these, 25 patients were diagnosed with OS perioperatively, corresponding to incidences of 1.6%, 2.7%, and 2.6% for acetabular, pelvic, and combined fractures, respectively. Risk factors included congestive heart failure, diabetes, concomitant traumatic lesions, head trauma, fractures of the cranial vault and/or basal skull, retroperitoneal hematomas and spinal cord injuries, and emergency internal fixation and extraperitoneal packing. Six (24%) patients underwent laparotomy, and all patients had ischemia or perforation of the cecum for which right hemicolectomy was performed. Ogilvie syndrome was associated with a significant increase in nosocomial infections, sepsis, pulmonary embolism, ICU stay, and prolonged hospital admission.

CONCLUSION

Ogilvie syndrome in patients with pelvic and/or acetabular fractures is associated with increased risk of perioperative complications and prolonged hospital and ICU stays, resulting in an increased risk of morbidity and mortality.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

COVID-19 Infection as a Possible Cause of Ogilvie's Syndrome

Ogilvie's syndrome is defined as acute dilatation of the colon in the absence of mechanical obstruction. Even though the precise mechanism is unknown, studies have suggested its association with autonomic nervous system dysfunction. Some of the common causes include infections, orthopedic surgery, renal failure, electrolyte disturbance, and narcotic use. Viral causes are considered to be rare; however, it is a well-known fact that viral infections can cause autonomic dysfunction. A few cases have been reported discussing the incidence of Ogilvie's syndrome in the setting of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). We present a unique case of Ogilvie's syndrome in a patient who initially presented with respiratory manifestations and subsequently developed acute colonic pseudo-obstruction.

A Case of Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome) in a Nonsurgical Patient with Plasma Cell Leukemia

Ogilvie’s syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare, nonobstructive dilation of the colon of unclear etiology. We present the case of a patient who presented with Ogilvie’s syndrome and significant hypokalemia due to colonic loss despite repletion. This case report demonstrates the difficulty in diagnosis, treatment, and outcome.

Refractory Hypokalemia in Secretory Diarrhea Phenotype of Colonic Pseudo-Obstruction (Ogilvie's Syndrome)

Colonic pseudo-obstruction is an acute non-obstructive colonic dilation associated with constipation or secretory diarrhea. The secretory diarrhea phenotype is associated with refractory hypokalemia that may require different interventions to treat. We present a case of a 51-year-old male who was admitted with a hemorrhagic stroke whose hospital course was complicated by severe abdominal distension, diarrhea, and hypokalemia. Initial investigations excluded infectious causes. Imaging confirmed colonic pseudo-obstruction. The hypokalemia was severe and refractory, requiring daily potassium replacement along with rectal tube decompression and spironolactone. Despite these interventions, the hypokalemia persists and requires nearly 100 days to resolve completely.

Potential Association Between Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) and Oral Nimodipine: Report of Two Cases

Nimodipine is a calcium channel blocker used for the management of patients with aneurysmal subarachnoid hemorrhage. Oral nimodipine has been rarely implicated in the development of acute colonic pseudo-obstruction (Ogilvie syndrome) in patients treated for aneurysmal subarachnoid hemorrhage. Nimodipine inhibits the transmembrane influx of calcium ions which are essential for the excitation-contraction coupling process of smooth muscle cells. We thought this mechanism of action could predispose patients to develop Ogilvie syndrome. This report aimed to examine the existing literature concerning the potential association between Ogilvie syndrome and nimodipine in patients with aneurysmal subarachnoid hemorrhage. All published cases of aneurysmal subarachnoid hemorrhage associated with Ogilvie syndrome were reviewed. We presented two female patients with aneurysmal subarachnoid hemorrhage produced after a ruptured anterior communicating artery aneurysm who received oral nimodipine and developed Ogilvie syndrome. The patients developed Ogilvie syndrome four to six days after receiving oral nimodipine. These two cases may further support the potential association of Ogilvie syndrome with the use of oral nimodipine during the treatment of patients with aneurysmal subarachnoid hemorrhage.

Acute Colonic Pseudo-Obstruction

Acute colonic pseudo-obstruction (ACPO) is a functional disorder of the large intestine distinguished by colonic dysmotility resulting in colonic distension in the absence of mechanical obstruction. The underlying pathophysiology of ACPO remains unclear despite technological advances in understanding the physiology of colonic motility, such as spatio-temporal mapping and high-resolution manometry. In many ways, the management of ACPO has remained relatively unchanged for 40 years. Patients with perforation or suspected ischemia undergo operative intervention, while patients without undergo initial conservative management with bowel rest, correction of electrolyte disturbances, and mobilization. Patients who fail conservative management or have prominent cecal dilatation undergo decompression with either neostigmine or colonoscopy. A subset of patients with ACPO will have recurrent symptoms despite endoscopic and medical management. For these patients who are difficult to manage, an underlying colonic functional disorder, such as slow-transit dysmotility or chronic intestinal pseudo-obstruction may be considered. The following review of ACPO aims to provide a concise update of the causes, diagnosis, and management of this emergency surgical condition.

Bowel perforation due to chronic idiopathic megacolon: Case report and literature review

INTRODUCTION AND IMPORTANCE

Chronic idiopathic megacolon is a rare condition characterized by an irreversible distension of the colon in the absence of organic disease. The pathogenesis of this condition is still unclear and the data in literatures are not consistent.

CASE PRESENTATION

We report a case of an 87-years-old woman affected by bowel perforation in chronic idiopathic megacolon. The patient underwent an emergency subtotal colectomy with terminal ileostomy. The postoperative was uneventful. At the histopathological examination, no organic cause of megacolon was found, so a diagnosis of idiopathic megacolon was done.

CLINICAL DISCUSSION

Idiopathic megacolon is difficult to diagnose due to the lack of specific clinical manifestations and pathological features. If not carefully investigated, can lead to severe complications such as perforation of the dilated bowel and subsequent peritonitis and sepsis, metabolic and electrolyte abnormalities. The protocols for management of IMC remains controversial. To achieve a good long-term outcome, early intervention is recommended.

CONCLUSION

Early diagnosis of idiopathic megacolon is needed to perform the best therapeutic strategy and prevent complications, but further studies are needed.

Main Bronchus Stenosis Due to Tuberculosis and Ogilvie's Syndrome: A Case Report of Two Unusual Diseases in the Same Patient

Main bronchus stenosis as a sequel of pulmonary tuberculosis is infrequent and should raise suspicion of other presentations of the infection. Given its non-specific symptomatology and the absence of a specific diagnostic method, tracheobronchial tuberculosis is usually not suspected and diagnosed despite its great impact on quality of life due to the high incidence of stenosis as a consequence. Ogilvie's syndrome, an uncommon condition, requires careful management and surveillance given the risk of ischemia and colonic perforation intrinsic to the disease. We present a case of a patient with main bronchus stenosis secondary to tuberculosis infection and Ogilvie's syndrome post-surgery.

Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) After Primary Spinal Fusion: An Analysis of Outcomes and Risk Factors from 2005 to 2014

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.

Incidence and Risk Factors for the Development of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) in Total Joint Arthroplasty Patients

BACKGROUND

Acute colonic pseudo-obstruction (Ogilvie syndrome [OS]) is a rare but devastating condition that can develop in orthopaedic patients postoperatively. The objective of this study was to identify the risk factors for developing OS after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to compare the outcomes between patients who did and did not develop OS postoperatively.

METHODS

This was a retrospective review using the National Inpatient Sample, a national database incorporating inpatient hospitalization information. ICD-9 codes were used to identify patients who underwent primary and revision THA or TKA. Patients were separated based on the diagnosis of OS. Primary outcomes assessed included patient mortality, postoperative complications, length of stay, and cost during index hospitalization.

RESULTS

From 2001 to 2014, a total of 12,541,169 patients underwent primary and revision THA or TKA. Of those, 3,182 patients (0.03%) developed OS postoperatively. There was an increased incidence of OS in revision THA and TKA compared with primary THA and TKA. Fluid and electrolyte disorders were associated with the largest increased adjusted risk of OS. Patients with OS had an increased adjusted risk of overall postoperative complications and being discharged to skilled nursing facility. Patients with OS had an increased average length of stay and hospitalization cost compared with patients without OS.

DISCUSSION

Given our findings, the risk factors for the development of OS, including revision surgery, should be identified and minimized during the perioperative period to prevent the development of this morbid and potentially life-threatening complication.

LEVEL OF EVIDENCE

III (Retrospective cohort study).

An "expressionistic" look at serrated precancerous colorectal lesions

Background

Approximately 60% of colorectal cancer (CRC) precursor lesions are the genuinely-dysplastic conventional adenomas (cADNs). The others include hyperplastic polyps (HPs), sessile serrated lesions (SSL), and traditional serrated adenomas (TSAs), subtypes of a class of lesions collectively referred to as “serrated.” Endoscopic and histologic differentiation between cADNs and serrated lesions, and between serrated lesion subtypes can be difficult.

Methods

We used in situ hybridization to verify the expression patterns in CRC precursors of 21 RNA molecules that appear to be promising differentiation markers on the basis of previous RNA sequencing studies.

Results

SSLs could be clearly differentiated from cADNs by the expression patterns of 9 of the 12 RNAs tested for this purpose (VSIG1, ANXA10, ACHE, SEMG1, AQP5, LINC00520, ZIC5/2, FOXD1, NKD1). Expression patterns of all 9 in HPs were similar to those in SSLs. Nine putatively HP-specific RNAs were also investigated, but none could be confirmed as such: most (e.g., HOXD13 and HOXB13), proved instead to be markers of the normal mucosa in the distal colon and rectum, where most HPs arise. TSAs displayed mixed staining patterns reflecting the presence of serrated and dysplastic glands in the same lesion.

Conclusions

Using a robust in situ hybridization protocol, we identified promising tissue-staining markers that, if validated in larger series of lesions, could facilitate more precise histologic classification of CRC precursors and, consequently, more tailored clinical follow-up of their carriers. Our findings should also fuel functional studies on the pathogenic significance of specific gene expression alterations in the initiation and evolution of CRC precursor subtypes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13000-020-01064-1.

Pseudoobstrucción colónica aguda (Sindrome de Ogilvie) posterior a una nefrectomía radical: Reporte de caso

El Sindrome de Ogilvie se caracteriza por una dilatación masiva del colon y una clínica sugestiva de obstrucción intestinal mecánica, sin causa orgánica. Presentamos un caso de dilatación aguda idiopática del colon secundaria a una cirugía abdominal.

El objetivo de este reporte fue la descripción de una patología urológica inusual que puede pasarse por alto o tratarse como un íleo adinámico y, la revisión de la literatura relacionada con la definición, factores de riesgos, etiología, fisiopatología y el tratamiento de la misma.

Paciente masculino de 61 años con antecedente de nefrectomía radical izquierda por tumor renal que, a las 48hs del alta hospitalaria, consultó por presentar distensión abdominal aguda. Se solicitó una radiografía abdominal y una tomografía computada que evidenciaba importante dilatación intestinal y un diámetro cecal mayor a 12cm.

Se practicó una laparotomía exploradora de urgencia constatándose dilatación colónica del colon transverso y ascendente con un cambio de diámetro a nivel del ángulo esplénico, sin causa osbtructiva. Finalmente, se realizó colostomía en asa.

A los 6 meses de seguimiento, la videocolonoscopía no mostró lesiones endoluminales concluyendo en un Sindrome de Ogilvie secundario a la nefrectomía. Finalmente, se efectuó reconstrucción del tránsito con buena evolución posterior.

En nuestro caso, el Sindrome de Ogilvie fue una complicación postoperatoria y como fallaron las terapias conservadoras iniciales instauradas, este reporte provee una modalidad de tratamiento alternativo. Si se reconoce temprano y se trata adecuadamente, la pseudoobstrucción se resolverá en la mayoría de los pacientes y la tasa de mortalidad posterior será menor.

Ogilvie Syndrome Following an Inflatable Penile Implant

A 59-year-old male patient presented with Ogilvie syndrome which developed after inflatable penile prosthesis placement. The patient presented to the emergency room three days after having an inflatable penile prosthesis with complaints of obstipation. A trial of conservative measures failed, and because of the development of peritonitis, the patient underwent a right hemicolectomy with a loop ileostomy.