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Sobrado LF, Foley NM, Lincango EP, Liska D, Gorgun E, Hull TL, Kessler H, Valente MA, Steele SR, Holubar SD. Acute colonic pseudo-obstruction: a retrospective review of the surgical outcomes. Langenbecks Arch Surg 2024; 409:178. [PMID: 38850452 DOI: 10.1007/s00423-024-03356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Limited data exist regarding the surgical outcomes of acute colonic pseudo-obstruction (ACPO), commonly referred to as Ogilvie syndrome, in modern clinical practice. The prevailing belief is that surgery should be avoided due to previously reported high mortality rates. We aimed to describe the surgical results of ACPO treated within our institution. METHODS Our prospectively maintained colorectal surgery registry was queried for patients diagnosed with ACPO, who underwent surgery between 2009 and 2022. Postoperative complications were graded according to Clavien-Dindo (CD) classification. The primary outcome was postoperative mortality. RESULTS A total of 32 patients who underwent surgery for ACPO were identified. Overall, nonoperative therapy was initially administered to 21 patients (65.6%). The surgeries performed included total abdominal colectomy (15, 43.1%), ascending colectomy with end ileostomy (8, 25%), transverse colostomy (5, 15.6%), ileostomy and transverse colostomy (3, 9.4%), and Hartmann's operation (1, 3.1%). Severe postoperative complications (CD grade 3 or 4) occurred in five patients (15.6%). No recurrence of ACPO was observed and no patient required reoperation. The average postoperative length of stay was 14.5 days, 30-day mortality was 6.3% (n = 2), and 90-day mortality was 15.6% (n = 5) due to complications of underlying comorbidities. CONCLUSIONS Surgical treatment was effective for patients with ACPO refractory to medical therapy or presenting with acute complications. Although postoperative complications were frequent, both the 30- and 90-day mortality rates were lower than previously documented in the literature. Further investigations are warranted to determine the optimal surgical strategy, which may involve total or segmental colectomy, or diversion alone without resection.
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Affiliation(s)
- Lucas F Sobrado
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA.
| | - Niamh M Foley
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Eddy P Lincango
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - David Liska
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Tracy L Hull
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Michael A Valente
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Stefan D Holubar
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
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2
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Smith T, Howick V JF, Sweetser S. 75-Year-Old Woman With Abdominal Distention. Mayo Clin Proc 2024; 99:832-835. [PMID: 38520449 DOI: 10.1016/j.mayocp.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 03/25/2024]
Affiliation(s)
- Thomas Smith
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - James F Howick V
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Seth Sweetser
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Pantel H, Reddy VB. Management of Colonic Emergencies. Surg Clin North Am 2023; 103:1133-1152. [PMID: 37838460 DOI: 10.1016/j.suc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
The etiology of colonic emergencies includes a wide-ranging and diverse set of pathologic conditions. Fortunately, for the surgeon treating a patient with one of these emergencies, the surgical management of these various causes is limited to choosing among proximal diversion, segmental colectomy with or without proximal diversion, or a total abdominal colectomy with end ileostomy (or rarely, an ileorectal anastomosis). The nuanced complexity in these situations usually revolves around the nonsurgical and/or endoscopic options and deciding when to proceed to the operating room.
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Affiliation(s)
- Haddon Pantel
- Colon and Rectal Surgery, Yale University School of Medicine, 450 George Street, New Haven, CT 06510, USA
| | - Vikram B Reddy
- Colon and Rectal Surgery, Yale University School of Medicine, 450 George Street, New Haven, CT 06510, USA.
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4
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Vanek P, Urban O, Falt P. Percutaneous endoscopic cecostomy for management of Ogilvie's syndrome: a case series and literature review with an update on current guidelines (with video). Surg Endosc 2023; 37:8144-8153. [PMID: 37500922 PMCID: PMC10519870 DOI: 10.1007/s00464-023-10281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Percutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endoscopy were recently published by three major expert societies, all within the last 2 years. PATIENTS AND METHODS We retrospectively identified three consecutive patients who underwent PEC placement at a Czech tertiary referral center between May 2018 and December 2021: all for recurrent ACPO. In addition, we summarized the current guidelines in order to present the latest knowledge related both to the procedure and management approach in patients with ACPO. RESULTS The placement of PEC was successful and resulted in clinical improvement in all cases without any adverse events. CONCLUSION The results of our experience are in line with previous reports and suggest that PEC may become a very useful tool in the armamentarium of modalities utilized to treat ACPO. Furthermore, the availability of guideline resources now offers comprehensive guidance for informed decision-making and the procedural aspects.
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Affiliation(s)
- Petr Vanek
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic.
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic.
| | - Ondrej Urban
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Premysl Falt
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
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5
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Numan L, Brotherton T, Baliss M, Ghosh S, Lamm V, Klos C, Sayuk G, Presti M, Elwing J. A Percutaneous Endoscopic Colostomy Tube to the Rescue. ACG Case Rep J 2023; 10:e01186. [PMID: 37868365 PMCID: PMC10586846 DOI: 10.14309/crj.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Percutaneous endoscopic colostomy (PEC) tube placement is a minimally invasive procedure used to treat recurrent colonic pseudo-obstruction, sigmoid volvulus, chronic intractable constipation, and neurogenic bowel. PEC is a viable treatment alternative for patients who have failed conservative therapies and are deemed high risk for surgical management. We present a case of acute colonic pseudo-obstruction after Clostridioides difficile infection that was unresponsive to medical treatment or endoscopic decompression. A PEC tube was placed into the transverse colon with successful resolution of the colonic distension.
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Affiliation(s)
- Laith Numan
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Tim Brotherton
- Department of Internal Medicine, St. Louis University, St. Louis, MO
| | - Michelle Baliss
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Soumojit Ghosh
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Vladimir Lamm
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
| | - Coen Klos
- Department of Surgery, St. Louis Veteran Affairs, St. Louis, MO
| | - Gregory Sayuk
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
| | - Michael Presti
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
| | - Jill Elwing
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
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Tasleem A, Finkelstein A, Waheed A. Ogilvie Syndrome, Bradycardia, and Neostigmine. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231184929. [PMID: 37457317 PMCID: PMC10338651 DOI: 10.1177/11795476231184929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
Acute colonic pseudo-obstruction (ACPO), known as Ogilvie Syndrome, is an acute dilation of the colon in the absence of an underlying mechanical or anatomic cause. Neostigmine treatment is indicated following failed conservative management of ACPO, however neostigmine has its contraindications. This is a report of a unique case of a patient with a past medical history of symptomatic first degree heart block with a permanent pacemaker who received a bolus dosage of neostigmine treatment for ACPO in an ICU setting.
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Affiliation(s)
- Asna Tasleem
- Family and Community Medicine, WellSpan Good Samaritan Hospital, Lebanon, PA, USA
| | - Adam Finkelstein
- Family Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Abdul Waheed
- Family and Community Medicine, WellSpan Good Samaritan Hospital, Lebanon, PA, USA
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Jayarajah U, Yapa K, Ranaweera K, Rahuman A, Perera P, Weerasekara D. Successful use of neostigmine for resistant gastroparesis following distal gastrectomy: A case report. Int J Surg Case Rep 2023; 106:108166. [PMID: 37068456 PMCID: PMC10130466 DOI: 10.1016/j.ijscr.2023.108166] [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: 12/16/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Although short acting acetyl cholinesterase inhibitors are used in colonic or small bowel pseudo-obstruction, their use in post-surgical gastroparesis is not clear. We demonstrate the successful use of neostigmine in a patient with resistant gastroparesis following distal gastrectomy. CASE PRESENTATION A 73-year-old male presented with features of gastric outflow obstruction 3 weeks following a distal gastrectomy. Prior to 3 weeks, he underwent an uneventful open distal gastrectomy for an incidentally detected low grade gastrointestinal stromal tumour (GIST) of the gastric antrum. An omega-loop isoperistaltic, 2-layer, posterior, retrocolic gastrojenunostomy was performed with a jejuno-jejunostomy. Abdominal ultrasonography was negative for intra-abdominal collections. Gastrograffin study and endoscopy ruled out an obstruction. A trial of prokinetics was unsuccessful with persistent nasogastric tube drain. Intravenous neostigmine was commenced with immediate symptomatic relief, reduction of abdominal distension and bowel evacuation without any cardiac adverse effects. At 6 months follow up, the patient was tolerating normal diet with no recurrence of symptoms. CLINICAL DISCUSSION The management of post-surgical gastroparesis is challenging. Although various prokinetics are described for gastric motility disorders, the studies among post-gastrectomy patients with gastroparesis are limited. In our patient, the successful administration of neostigmine avoided the morbidity due to revision surgery. CONCLUSION The use of neostigmine infusion was safe and effective for post-surgical gastroparesis after distal gastrectomy in our patient. To date, there are no trials investigating the place of neostigmine for resistant gastroparesis after gastric surgery and future studies are warranted prior to routine use in clinical practice.
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Affiliation(s)
- Umesh Jayarajah
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka.
| | - Kalana Yapa
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Kasun Ranaweera
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Abdul Rahuman
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Pasindu Perera
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Deepaka Weerasekara
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
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8
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Muacevic A, Adler JR, Devi P, Nwani SO, Dogar M. Persistent Hypokalemia in a Patient With Ogilvie's Syndrome. Cureus 2022; 14:e32056. [PMID: 36600873 PMCID: PMC9802540 DOI: 10.7759/cureus.32056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
Ogilvie's syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare disease characterized by acute dilatation of the colon in the absence of anatomic intestinal obstruction. It is of clinical importance because of its preponderance in elderly males in the seventh decade of life who may present with constipation or diarrhea. We present an 80-year-old male who presented with diarrhea, with laboratory investigations showing hypokalemia and a CT abdomen revealing colonic distension. The patient was wasting potassium both from colon and renal losses, despite low aldosterone levels. The patient was treated with Neostigmine, which helped relieve abdominal distention. Subsequently, potassium was corrected with aggressive replacement. This case sheds light on newer modalities of treatment such as neostigmine, as in this case.
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9
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Ziroglu N, Oruç SÖ. Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) after Hip Arthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:458-461. [PMID: 34261168 DOI: 10.1055/a-1527-8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ogilvie's syndrome is a clinical entity that occurs with signs of excessive dilatation of the colon and obstruction, despite the absence of a mechanical obstruction. Although its etiology remains uncertain, anticholinergic drugs, metabolic disorders, diabetes mellitus, hyperparathyroidism, Parkinson's disease, major orthopedic interventions, or blunt abdominal trauma are considered to be possible causes. Imbalance in sympathetic innervation plays a role in the pathogenesis. The characteristic feature of the syndrome is the presence of a major trauma or surgical history. Although this is an uncommon complication, especially after hip and knee arthroplasty, it is an important cause of mortality and morbidity. Conservative or surgical colonic decompression and anticholinergic agents play a role in the treatment of Ogilvie's syndrome, which is defined as acute colonic pseudo-obstruction (ACPO). In this case report, we present the postoperative process of an elderly patient with comorbid diseases who underwent hemiarthroplasty due to a hip fracture as a result of a domestic fall. We will discuss the diagnosis of ACPO and the approach to multidisciplinary management of the treatment in a case that is frequently encountered in daily practice and starts as a normal report. We aim to remind surgeons that they may encounter ACPO in the postoperative period and to emphasize that mortality and morbidity can be reduced with early diagnosis and a multidisciplinary approach. We would like to emphasize that Ogilvie's syndrome should be included in the differential diagnosis portfolio of all orthopedic surgeons.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Beylikduzu State Hospital, Istanbul, Turkey
| | - Sevinç Ödül Oruç
- Orthopedics and Traumatology, Hatay Antakya State Hospital, Antakya, Turkey
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10
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Xu S, Sharma S, Jadbabaie F. Management of acute colonic pseudo-obstruction in a neutropenic patient. BMJ Case Rep 2022; 15:e250633. [PMID: 35793843 PMCID: PMC9260809 DOI: 10.1136/bcr-2022-250633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 12/16/2022] Open
Abstract
Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, is a rare condition involving acute large bowel dilatation without mechanical obstruction. Management begins with conservative treatment and may include pharmacological therapy, colonoscopic decompression and surgery. Timely resolution is important due to the increased risk of bowel perforation and ischaemia associated with colonic dilatation. However, conditions such as neutropenia that place patients at an elevated risk of infection may limit treatment options. We report a case of acute colonic pseudo-obstruction in a neutropenic elderly man resistant to conservative measures and neostigmine and discuss the additional management considerations in an immunocompromised patient.
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Affiliation(s)
- Suzanne Xu
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shreyak Sharma
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farid Jadbabaie
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Abstract
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.
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Affiliation(s)
- Thomas Arthur
- Department of Colorectal Surgery, Austin Hospital, Melbourne, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Adele Burgess
- Department of Colorectal Surgery, Austin Hospital, Melbourne, Australia
- School of Medicine, University of Melbourne, Melbourne, Australia
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Keller J, Wedel T, Seidl H, Kreis ME, van der Voort I, Gebhard M, Langhorst J, Lynen Jansen P, Schwandner O, Storr M, van Leeuwen P, Andresen V, Preiß JC, Layer P, Allescher H, Andus T, Bischoff SC, Buderus S, Claßen M, Ehlert U, Elsenbruch S, Engel M, Enninger A, Fischbach W, Freitag M, Frieling T, Gillessen A, Goebel-Stengel M, Gschossmann J, Gundling F, Haag S, Häuser W, Helwig U, Hollerbach S, Holtmann G, Karaus M, Katschinski M, Krammer H, Kruis W, Kuhlbusch-Zicklam R, Lynen Jansen P, Madisch A, Matthes H, Miehlke S, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Posovszky C, Raithel M, Röhrig-Herzog G, Schäfert R, Schemann M, Schmidt-Choudhury A, Schmiedel S, Schweinlin A, Schwille-Kiuntke J, Stengel A, Tesarz J, Voderholzer W, von Boyen G, von Schönfeld J. Update S3-Leitlinie Intestinale Motilitätsstörungen: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:192-218. [PMID: 35148561 DOI: 10.1055/a-1646-1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jutta Keller
- Medizinische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland
| | - Thilo Wedel
- Institut für Anatomie, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Holger Seidl
- Klinik für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Isarklinikum München, München, Deutschland
| | - Martin E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité, Campus Benjamin Franklin, Berlin, Deutschland
| | - Ivo van der Voort
- Klinik für Innere Medizin - Gastroenterologie und Diabetologie, Jüdisches Krankenhaus Berlin, Deutschland
| | | | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum Bamberg, Bamberg, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - Oliver Schwandner
- Abteilung für Proktologie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Martin Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg
| | - Pia van Leeuwen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - Viola Andresen
- Medizinische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland
| | - Jan C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Klinikum Neukölln, Berlin
| | - Peter Layer
- Medizinische Klinik, Israelitisches Krankenhaus in Hamburg, Hamburg, Deutschland
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13
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John AA, Anand R, Frost J, Griswold JA. Acute Colonic Pseudo-Obstruction: A critical complication in burn patients. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Lethal Acute Colonic Pseudo-Obstruction in a Patient Using a Combination of Olanzapine and Clozapine. J Clin Psychopharmacol 2022; 42:511-513. [PMID: 35916591 PMCID: PMC9426750 DOI: 10.1097/jcp.0000000000001587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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16
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Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046-1057. [PMID: 34016826 DOI: 10.1097/dcr.0000000000002159] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Karim Alavi
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Jennifer S Davids
- University of Massachusetts Medical School, Worcester, Massachusetts
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17
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Hardy NP, McEntee PD, McCormick PH, Mehigan BJ, Larkin JO. Sigmoid volvulus: definitive surgery is safe and should be considered in all instances. Ir J Med Sci 2021; 191:1291-1295. [PMID: 34327621 PMCID: PMC9135785 DOI: 10.1007/s11845-021-02713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Background Acute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence. Objective We sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution. Methods Hospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded. Results Thirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group. Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus. Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data. Conclusion There is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.
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Affiliation(s)
- Niall P Hardy
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Philip D McEntee
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Paul H McCormick
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - Brian J Mehigan
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland
| | - John O Larkin
- Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland.
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18
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Underhill J, Munding E, Hayden D. Acute Colonic Pseudo-obstruction and Volvulus: Pathophysiology, Evaluation, and Treatment. Clin Colon Rectal Surg 2021; 34:242-250. [PMID: 34305473 DOI: 10.1055/s-0041-1727195] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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.
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Affiliation(s)
- Joshua Underhill
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Emily Munding
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Dana Hayden
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
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19
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Wells CI, Paskaranandavadivel N, Du P, Penfold JA, Gharibans A, Bissett IP, O'Grady G. A novel mechanism for acute colonic pseudo-obstruction revealed by high-resolution manometry: A case report. Physiol Rep 2021; 9:e14950. [PMID: 34231325 PMCID: PMC8261480 DOI: 10.14814/phy2.14950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) is a severe form of colonic dysmotility and is associated with considerable morbidity. The pathophysiology of ACPO is considered to be multifactorial but has not been clarified. Although colonic motility is commonly assumed to be hypoactive, there is little direct pathophysiological evidence to support this claim. METHODS A 56-year-old woman who developed ACPO following spinal surgery underwent 24 h of continuous high-resolution colonic manometry (1 cm resolution over 36 cm) following endoscopic decompression. Manometry data were analyzed and correlated with a three-dimensional colonic model developed from computed tomography (CT) imaging. RESULTS The distal colon was found to be profoundly hyperactive, showing near-continuous non-propagating motor activity. Dominant frequencies at 2-6 and 8-12 cycles per minute were observed. The activity was often dissociated and out-of-phase across adjacent regions. The mean amplitude of motor activity was higher than that reported from pre- and post-prandial healthy controls. Correlation with CT imaging suggested that these disordered hyperactive motility sequences might act as a functional pseudo-obstruction in the distal colon resulting in secondary proximal dilatation. CONCLUSIONS This is the first detailed description of motility patterns in ACPO and suggests a novel underlying disease mechanism, warranting further investigation and identification of potential therapeutic targets.
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Affiliation(s)
- Cameron I. Wells
- Department of SurgeryFaculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | | | - Peng Du
- Auckland Bioengineering InstituteThe University of AucklandAucklandNew Zealand
| | - James A. Penfold
- Department of SurgeryFaculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Armen Gharibans
- Department of SurgeryFaculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
- Auckland Bioengineering InstituteThe University of AucklandAucklandNew Zealand
| | - Ian P. Bissett
- Department of SurgeryFaculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Greg O'Grady
- Department of SurgeryFaculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
- Auckland Bioengineering InstituteThe University of AucklandAucklandNew Zealand
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20
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Bell CM, Procter LD, Parli SE. Asystole Following Concomitant Intravenous Administration of Neostigmine and Dexmedetomidine in a Patient With Acute Colonic Pseudo-Obstruction. J Pharm Pract 2021; 35:650-653. [PMID: 33739166 DOI: 10.1177/08971900211001278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute colonic pseudo-obstruction (ACPO) is a condition characterized by acute dilation of the large bowel without evidence of mechanical obstruction that occurs in a variety of hospitalized patients with many predisposing factors. Management includes supportive care and limitation of offending medications with mainstays of treatment of neostigmine administration and colonic decompression. We report the case of a critically ill patient with ACPO who experienced bradycardia and a brief episode of asystole when receiving concomitant dexmedetomidine and neostigmine infusions but who later remained hemodynamically stable when receiving propofol and neostigmine infusions. The bradycardia and associated hemodynamic instability experienced while on dexmedetomidine and neostigmine infusions were rapidly corrected with atropine and cessation of offending agents. Because ACPO is encountered frequently and the use of dexmedetomidine as a sedative agent in the ICU is increasing, practitioners should be aware of the additive risk of bradycardia and potential for asystole with the combination of neostigmine and dexmedetomidine. Electronic drug interaction databases should be updated and drug information sources should include a drug-drug interaction between dexmedetomidine and neostigmine to reduce the likelihood of concomitant administration.
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Affiliation(s)
- Carolyn Magee Bell
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Levi D Procter
- Department of General Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara E Parli
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.,Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
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21
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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22
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Peng Y, Peng C. Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report. BMC Pregnancy Childbirth 2020; 20:727. [PMID: 33238905 PMCID: PMC7687834 DOI: 10.1186/s12884-020-03414-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications. Case presentation A 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later. Conclusion Ogilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.
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Affiliation(s)
- Ying Peng
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei, 230001, Anhui, P. R. China.
| | - Cheng Peng
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei, 230001, Anhui, P. R. China
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23
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Gentili G, Colella MF, Deluca A, Pérez PL, Rossi PC, Damia OPA, Laplumé EE, Sarno PL. Pseudoobstrucción colónica aguda (Sindrome de Ogilvie) posterior a una nefrectomía radical: Reporte de caso. Rev Urol 2020. [DOI: 10.1055/s-0040-1718459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ResumenEl 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.
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Affiliation(s)
- Georgina Gentili
- Departamento de Urología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
| | - María Florencia Colella
- Departamento de Urología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
| | - Agustín Deluca
- Departamento de Urología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
| | - Pablo Leonardo Pérez
- Departamento de Urología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
| | - Pablo Cesar Rossi
- Departamento de Urología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
| | | | | | - Patricio Lucio Sarno
- Departamento de Urología, Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires, Argentina
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24
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Gupta AK, Farshchian J. Ogilvie Syndrome Following an Inflatable Penile Implant. Cureus 2020; 12:e9279. [PMID: 32821622 PMCID: PMC7431308 DOI: 10.7759/cureus.9279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Joseph Farshchian
- Surgery, Florida Atlantic University College of Medicine, Boca Raton, USA
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25
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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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26
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Christensen K, Ostersen LH, Glavind K, Krarup AL, Kjærgaard N. Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆. Eur J Obstet Gynecol Reprod Biol 2020; 252:418-423. [PMID: 32721839 DOI: 10.1016/j.ejogrb.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether women who developed acute colonic pseudo-obstruction (ACPO) after cesarean section have a higher degree of gastro-intestinal symptoms than women who did not develop ACPO after cesarean section. ACPO is a colonic dilatation without mechanical obstruction, and with an unknown pathophysiology. In younger people it is mostly seen in women after cesarean section. The hypothesis of the present study is that long-term consequences of gastrointestinal symptoms evolve after ACPO, due to the impact on the colon. STUDY DESIGN 40 women who developed ACPO after cesarean section (cases) and 80 women, who did not develop ACPO after cesarean section (controls), were asked to participate in the study. The controls were matched based on time of cesarean section (± 14 days), age (±5 years), singleton or twin, parity, cesarean section grade, and ASA-group. Baseline characteristics and information regarding the cesarean section were collected from medical records. An electronic collection of surveys was distributed to the participants, including the following: Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS), Rome IV, Gastrointestinal Symptoms Rating Scale (GSRS), Visceral Sensitivity Index (VSI), Patient Health Questionnaire 15 (PHQ15), The MOS 36-item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The score from IBS-SSS after cesarean section was used as the primary outcome. RESULTS 25 cases and 37 controls participated in the study. A difference in blood loss was found with a median of 600 mL in cases, compared to 400 mL in controls during cesarean section (p = 0.002). No difference was found between cases and controls in the IBS-SSS score after cesarean section. However, cases yielded a higher difference between IBS-SSS before and after cesarean section, indicating a higher degree of deterioration in gastrointestinal symptoms (p = 0.026). In addition, cases reported a higher degree of pain in everyday life (p = 0.039). No difference was found in the remaining surveys. CONCLUSION Women undergoing cesarean section developed mild grade of irritable bowel syndrome. However, gastrointestinal symptoms did not seem to be more prevalent in women who developed ACPO, although women with ACPO had a higher degree of deterioration in gastrointestinal symptoms than controls.
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Affiliation(s)
| | - Line H Ostersen
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Karin Glavind
- Department of Obstetrics and Gynecology, Aalborg University Hospital (AAUH), Denmark
| | - Anne L Krarup
- Department of Gastroenterology, Vendsyssel Hospital, Denmark
| | - Niels Kjærgaard
- Department of Obstetrics and Gynecology, Aalborg University Hospital (AAUH), Denmark
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Garbuzenko DV, Belov DV, Arefyev NO. A rare complication of cardiac surgery: Ogilvie syndrome. J Postgrad Med 2020; 65:56-57. [PMID: 30693875 PMCID: PMC6380123 DOI: 10.4103/jpgm.jpgm_405_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- D V Garbuzenko
- Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russia
| | - D V Belov
- Department of Faculty Surgery, South Ural State Medical University; Department of Hospital Surgery, Federal State Budgetary Institution "Federal Center of Cardiovascular Surgery," Chelyabinsk, Russia
| | - N O Arefyev
- Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russia
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Scott M, Konstantatos AH, Bui T, Carne P, O'Donohoe R, Dearaugo S, Donovan S. Acute colonic pseudo‐obstruction leading to perforation: a case‐control study investigating associations to tapentadol. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthew Scott
- Pharmacy Department, Alfred Health Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Alex H. Konstantatos
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
- Faculty of Medicine Zhejiang University Hangzhou China
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
| | - Thuy Bui
- Pharmacy Department, Alfred Health Faculty of Pharmacy and Pharmaceutical Sciences Monash University Melbourne Australia
| | - Peter Carne
- Cabrini Hospital Department of Surgery Monash University Melbourne Australia
| | - Rory O'Donohoe
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
| | - Stephanie Dearaugo
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
| | - Sarah Donovan
- Department of Anaesthesia and Perioperative Medicine Alfred Hospital Melbourne Australia
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American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc 2020; 91:228-235. [PMID: 31791596 DOI: 10.1016/j.gie.2019.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
Colonic volvulus and acute colonic pseudo-obstruction (ACPO) are 2 causes of benign large-bowel obstruction. Colonic volvulus occurs most commonly in the sigmoid colon as a result of bowel twisting along its mesenteric axis. In contrast, the exact pathophysiology of ACPO is poorly understood, with the prevailing hypothesis being altered regulation of colonic function by the autonomic nervous system resulting in colonic distention in the absence of mechanical blockage. Prompt diagnosis and intervention leads to improved outcomes for both diagnoses. Endoscopy may play a role in the evaluation and management of both entities. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO.
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Jeong SJ, Park J. Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction. Clin Endosc 2019; 53:18-28. [PMID: 31645090 PMCID: PMC7003002 DOI: 10.5946/ce.2019.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023] Open
Abstract
There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.
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Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Mahoney JR, Barnes D, Pahl D. Perforated ileus after L5-S1 anterior lumbar interbody fusion: a case report presentation. AME Case Rep 2019; 3:21. [PMID: 31463426 DOI: 10.21037/acr.2019.07.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
Acute colonic pseudo-obstruction (ACPO) as a result of anterior lumbar spinal surgery can result in colonic perforation. ACPO is often treated successfully with conservative measures, reserving surgical intervention for severe cases. The most severe cases can result in colonic perforation with a concomitant high mortality rate. Herein we outline a case of a 72-year-old male with multiple medical comorbidities and history of intermittent constipation who underwent anterior lumbar interbody fusion (ALIF) of L5-S1. The patient's multiple medical comorbidities placed him at risk for ACPO. His postoperative course was complicated by an ileus. The patient initially underwent conservative management that failed, resulting in colonic perforation. He underwent urgent exploratory laparotomy and repair of colonic perforation by the general surgery service. The patient had spontaneous return of bowel function on postoperative day 5, and at 6 months, he was doing well. The main purpose of this case report is to present a unique case of colonic perforation after ALIF. Understanding patient risk factors can help in early identification and treatment of potentially life-threatening complications. Surgeons should discuss the possibility of this complication with the patient during surgical counseling for anterior lumbar surgery.
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Affiliation(s)
- J Ryan Mahoney
- Jack Hughston Memorial Hospital Orthopedic Surgery Residency Program, Phenix City, AL, USA.,The Hughston Foundation Inc. and The Hughston Clinic, Columbus, GA, USA
| | - David Barnes
- Jack Hughston Memorial Hospital Orthopedic Surgery Residency Program, Phenix City, AL, USA.,The Hughston Foundation Inc. and The Hughston Clinic, Columbus, GA, USA
| | - Douglas Pahl
- Jack Hughston Memorial Hospital Orthopedic Surgery Residency Program, Phenix City, AL, USA.,The Hughston Foundation Inc. and The Hughston Clinic, Columbus, GA, USA
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Cheong JY, Byrne C, Austin K. Novel technique of insertion of decompression tube for Ogilvie's syndrome/colonic pseudo-obstruction. ANZ J Surg 2019; 90:150-151. [PMID: 31450262 DOI: 10.1111/ans.15371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/27/2019] [Accepted: 06/22/2019] [Indexed: 12/23/2022]
Abstract
Novel technique of management of colonic pseudo-obstructing using colonoscopy guided insertion of decompression tube.
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Affiliation(s)
- Ju Yong Cheong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kirk Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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33
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Hughes AE, Smart NJ, Daniels IR. Acute colonic pseudo‐obstruction after caesarean section: a review and recommended management algorithm. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/tog.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alice E Hughes
- Academic Clinical Fellow and ST2 trainee in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology Rosie Hospital Cambridge CB2 0QQ UK
| | - Neil J Smart
- Consultant Colorectal Surgeon, Royal Devon and Exeter NHS Foundation Trust and Honorary Associate Professor, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
| | - Ian R Daniels
- Consultant Colorectal Surgeon, Royal Devon and Exeter Hospital NHS Foundation Trust and Honorary Clinical Senior Lecturer, University of Exeter Medical School Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital Exeter EX2 5DW UK
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Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg 2019; 14:20. [PMID: 31168315 PMCID: PMC6489175 DOI: 10.1186/s13017-019-0240-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal pain associated with intestinal obstruction.
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Affiliation(s)
- Fausto Catena
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Belinda De Simone
- 1Emergency and Trauma Surgery Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | | | | | | | - Luca Ansaloni
- Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy
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35
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Pseudo-obstruction But a Real Perforation. AORN J 2018; 109:142-144. [PMID: 30592523 DOI: 10.1002/aorn.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gu L, Yang B, Zhang X, Ding C, Tian H, Zhu W, Li J, Li N. Fluoroscopy-guided trans-anal decompression tube placement in the treatment of acute colonic pseudo-obstruction: a single center experience. Abdom Radiol (NY) 2018; 43:2643-2650. [PMID: 29470625 DOI: 10.1007/s00261-018-1509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Acute colonic pseudo-obstruction (ACPO or Ogilvie's syndrome) is a rare but often fatal disease; timely colonic decompression may be essential for successful treatment. This study describes a technique of placing a trans-anal tube via fluoroscopy-guiding and investigates the effect of colon decompression on ACPO. METHODS Patients undergoing colonic decompression via fluoroscopy-guided trans-anal tube placement from April 2015 to May 2017 were included. The technical and clinical successes of this procedure were evaluated. Clinical features and long-term outcomes are described. RESULTS Decompression was successful in 72.73% (16/22) of the patients; the procedure was considered a clinical success in 50% (11/22) of the patients. 31.82% (7/22) of the patients underwent elective surgery, and only 18.19% (4/22) of the patients need emergency surgery. CONCLUSIONS Fluoroscopy-guided trans-anal decompression tube placement was an easy and efficient method for treating ACPO. Additionally, ACPO once required emergency surgery, but now may only require elective surgery in certain instances.
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Abstract
Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, refers to pathologic dilation of the colon without underlying mechanical obstruction, occurring primarily in patients with serious comorbidities. Diagnosis of Ogilvie's syndrome is based on clinical and radiologic grounds, and can be treated conservatively or with interventions such as acetylcholinesterase inhibitors (such as neostigmine), decompressive procedures including colonoscopy, and even surgery. Based on our clinical experience we hypothesized that conservative management yields similar, if not superior, results to interventional management. Therefore, we retrospectively examined all patients over the age of 18 with Ogilvie's syndrome who presented to the Medical University of South Carolina (MUSC). The diagnosis of Ogilvie's syndrome was confirmed by clinical criteria, including imaging evidence of colonic dilation ≥9 cm. Patients were divided and analyzed in 2 groups based on management: conservative (observation, rectal tube, nasogastric tube, fluid resuscitation, and correction of electrolytes) and interventional (neostigmine, colonoscopy, and surgery). Use of narcotics in relation to maximal bowel size was also analyzed. Over the 11-year study period (2005-2015), 37 patients with Ogilvie's syndrome were identified. The average age was 67 years and the average maximal bowel diameter was 12.5 cm. Overall, 19 patients (51%) were managed conservatively and 18 (49%) underwent interventional management. There was no significant difference in bowel dilation (12.0 cm vs 13.0 cm; P = .21), comorbidities (based on the Charlson Comorbidity Index (CCI), 3.2 vs 3.4; P = .74), or narcotic use (P = .79) between the conservative and interventional management groups, respectively. Of the 18 patients undergoing interventional management, 11 (61%) had Ogilvie's-syndrome-related complications compared to 4 (21%) of the 19 patients in the conservative management group (P < .01). There was no difference in overall length of stay in the 2 groups. Two patients, one in each group, died from complications unrelated to their Ogilvie's syndrome. We conclude that Ogilvie's syndrome, although uncommon, and typically associated with severe underlying disease, is currently associated with a low inpatient mortality. While interventional management is often alluded to in the literature, we found no evidence that aggressive measures lead to improved outcomes.
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Affiliation(s)
- Magda Haj
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Mona Haj
- Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC
| | - Don C. Rockey
- Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC
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Abstract
Critical illness and injury affect the gastrointestinal tract almost uniformly. Complications include the sequelae of direct intestinal injury and repair, impaired motility, intra-abdominal hypertension, and ulceration, among others. Contemporary clinical practice has incorporated many advances in the prevention and treatment of gastrointestinal complications during critical illness. This article discusses the epidemiology, risk factors, means of diagnosis, treatment, and prevention of some of these compilations.
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Affiliation(s)
- Rowan Sheldon
- Madigan Army Medical Center, Department of Surgery, General Surgery, MCHJ-CLS-G, Tacoma, WA 98431, USA
| | - Matthew Eckert
- Madigan Army Medical Center, Department of Surgery, General Surgery, MCHJ-CLS-G, Tacoma, WA 98431, USA.
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Bazerbachi F, Haffar S, Szarka LA, Wang Z, Prokop LJ, Murad MH, Camilleri M. Secretory diarrhea and hypokalemia associated with colonic pseudo-obstruction: A case study and systematic analysis of the literature. Neurogastroenterol Motil 2017; 29. [PMID: 28580600 DOI: 10.1111/nmo.13120] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colonic pseudo-obstruction (CPO) is characterized by colonic distention in the absence of mechanical obstruction or toxic megacolon. Concomitant secretory diarrhea (SD) with hypokalemia (SD-CPO) due to gastrointestinal (GI) loss requires further characterization. AIM To perform a systematic review of SD-CPO, report a case study, and compare SD-CPO with classical CPO (C-CPO). METHODS We performed a search of MEDLINE, EMBASE, Cochrane, and Scopus for reports based on a priori criteria for CPO, SD and GI loss of potassium. An additional case at Mayo Clinic was included. RESULTS Nine publications met inclusion criteria, with a total of 14 cases. Six studies had high, three moderate, and our case high methodological quality. Median age was 74 years (66-97), with 2:1 male/female ratio. Kidney disease was present in 6/14 patients. Diarrhea was described as profuse, watery, or viscous in 10 patients. Median serum, stool, and urine potassium concentrations (mmol/L) were 2.4 (range: 1.9-3.1), 137 (100-180), and 17 (8-40), respectively. Maximal diameter of colon and cecum (median) were 10.2 cm and 10.5 cm, respectively. Conservative therapy alone was effective in five out of 14 patients. Median potassium supplementation was 124 mEq/d (40-300). Colonic decompression was effective in three out of six patients; one had a total colectomy; three out of 14 had died. The main differences between SD-CPO and C-CPO were lower responses to treatments: conservative measures (35.7% vs 73.6%, P=.01), neostigmine (17% vs 89.2%, P<.001), and colonic decompression (50% vs 82.4%, P=.02). CONCLUSION SD-CPO is a rare phenotype associated with increased fecal potassium and is more difficult to treat than C-CPO.
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Affiliation(s)
- F Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S Haffar
- Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic
| | - L A Szarka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Z Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - L J Prokop
- Library Public Services, Mayo Clinic, Rochester, MN, USA
| | - M H Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - M Camilleri
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Chung JY, Park JS, Kim YS. A Rare Cause of Acute Colonic Pseudo-obstruction: Ogilvie's Syndrome Caused by Herpes Zoster. J Neurogastroenterol Motil 2017; 23:616-617. [PMID: 28992679 PMCID: PMC5628995 DOI: 10.5056/jnm17078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Jae Yoon Chung
- Department of Anesthesiology, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Korea
| | - Jong Seol Park
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Korea
| | - Yong Sung Kim
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Korea
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Robinson AJ, Quigley JP, Banks A, Farmer M. Ogilvie's syndrome treated with an emergency laparotomy, right hemicolectomy and end ileostomy. BMJ Case Rep 2017; 2017:bcr-2017-220916. [PMID: 29018144 DOI: 10.1136/bcr-2017-220916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is a rare clinical entity in which there is massive non-toxic colonic dilatation in the absence of a mechanically obstructing lesion. It is an important yet poorly recognised cause of surgical morbidity and mortality occurring typically in elderly patients with multiple comorbidities. ACPO can often be reversed conservatively with colonoscopic or nasogastric decompression. Surgical intervention is seldom necessary. We present a case of Ogilvie's syndrome in which a healthy 76-year-old man developed life-threatening pseudo-obstruction following rib polytrauma after a mechanical fall. Pneumatosis coli was evident radiologically, prompting emergency exploratory laparotomy. Operative findings of serosal tearing and ischaemic colitis necessitated treatment with right hemicolectomy and ileostomy formation. Microbiological and histopathological analyses proved negative for inflammatory, obstructive and infectious colitides. The case emphasises the importance of early recognition and timely intervention in the management of this rare yet potentially fatal cause of megacolon.
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Affiliation(s)
| | - John-Patrick Quigley
- Department of General Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Athene Banks
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Martin Farmer
- The Royal Stoke University Hospital, Stoke-on-Trent, UK
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Adiamah A, Johnson S, Ho A, Orbell J. Neostigmine and glycopyrronium: a potential safe alternative for patients with pseudo-obstruction without access to conventional methods of decompression. BMJ Case Rep 2017; 2017:bcr-2017-221249. [PMID: 28893807 DOI: 10.1136/bcr-2017-221249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intestinal pseudo-obstruction mimics bowel obstruction. However, on examination, no mechanical cause is identified. This condition will often resolve when managed conservatively, yet in some cases decompression is required to avoid the serious complications of bowel ischaemia and perforation. This is performed endoscopically, and due to the invasive nature and limited access to this service, an alternative treatment option is deemed appealing. Neostigmine has good efficacy in the decompression of pseudo-obstruction but is hindered by its wide side effect profile. In this context, neostigmine requires careful monitoring, which limits its appeal. This side effect profile is minimised when neostigmine is administered in conjunction with glycopyrronium.This case demonstrates the novel use of neostigmine and glycopyrronium in decompression of the bowel in a patient with pseudo-obstruction. Furthermore, it highlights its value, particularly when conventional techniques for decompression are not accessible.
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Affiliation(s)
- Alfred Adiamah
- Nottingham University Hospitals NHS Trust, Dorset County Hospital, Nottingham, UK
| | - Sarah Johnson
- Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Adrian Ho
- Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - James Orbell
- Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
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Wells CI, O’Grady G, Bissett IP. Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms. World J Gastroenterol 2017; 23:5634-5644. [PMID: 28852322 PMCID: PMC5558126 DOI: 10.3748/wjg.v23.i30.5634] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 07/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODS A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTS No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSION Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
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Orfanelli T, Chung S, Kohut A, Gibbon D, Leiser A. Ogilvie's Syndrome after Robotic-Assisted Radical Hysterectomy for Cervical Cancer. J Minim Invasive Gynecol 2017; 25:175-179. [PMID: 28711762 DOI: 10.1016/j.jmig.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 12/16/2022]
Abstract
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is defined by poor peristaltic activity of the colon that mimics mechanical obstruction in the absence of any mechanical occlusive gut lesion. This case report is the first to be published on ACPO occurring after robotic-assisted radical hysterectomy. Given that robotic-assisted laparoscopic surgery has become the next major stage of advancement for a range of operations, especially in gynecologic oncology surgery, this report emphasizes the importance of recognizing precipitating factors associated with this syndrome, including minimally invasive surgery.
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Affiliation(s)
- Theofano Orfanelli
- Department of Obstetrics, Gynecology, and Reproductive Science, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | - Stephanie Chung
- Department of Obstetrics, Gynecology, and Reproductive Science, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Adrian Kohut
- Department of Obstetrics, Gynecology, and Reproductive Science, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Aliza Leiser
- Department of Obstetrics, Gynecology, and Reproductive Science, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Zhao C, Xie T, Li J, Cheng M, Shi J, Gao T, Xi F, Shen J, Cao C, Yu W. Acute Colonic Pseudo-Obstruction with Feeding Intolerance in Critically Ill Patients: A Study according to Gut Wall Analysis. Gastroenterol Res Pract 2017; 2017:9574592. [PMID: 28386273 PMCID: PMC5366232 DOI: 10.1155/2017/9574592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/16/2016] [Accepted: 01/26/2017] [Indexed: 12/13/2022] Open
Abstract
Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared. Results. Patients in ACPO-T group had a significantly higher APACHE II (11.82 versus 8.25, p = 0.008) and SOFA scores (6.47 versus 3.54, p < 0.001) and a significantly higher 28-day mortality (17.78% versus 4.16%, p = 0.032) and longer intensive care unit stage (4 versus 16 d, p < 0.001). Patients in ACPO-NT group were more likely to be responsive to supportive treatment (62.50% versus 24.44%, p < 0.001), neostigmine (77.78% versus 17.64%, p < 0.001), and colonoscopic decompression (75% versus 42.86%, p = 0.318) than those in ACPO-T group. Of the patients who underwent ileostomy, 81.25% gained benefits. Conclusions. ACPO patients with gut wall thickening are more severe and are less likely to be responsive to nonsurgical treatment. Ileostomy may be a good option for ACPO patients with gut wall thickening who are irresponsive to nonsurgical treatment.
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Affiliation(s)
- Chenyan Zhao
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
- Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China
| | - Tingbin Xie
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
- Southern Medical University, No. 1023 Shatai South Road, Guangzhou 510515, China
| | - Jun Li
- Jining No.1 People's Hospital, No. 99 Jianshe West Road, Jining 272000, China
| | - Minhua Cheng
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
- Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China
| | - Jialiang Shi
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
| | - Tao Gao
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
| | - Fengchan Xi
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
| | - Juanhong Shen
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
| | - Chun Cao
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
- Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China
| | - Wenkui Yu
- Research Institute of General Surgery, Jinling Hospital, No. 305 Zhongshan East Road, Nanjing 210002, China
- Medical School, Nanjing University, No. 22 Hankou Road, Nanjing 210002, China
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Abdalla S, Brouquet A, Lazure T, Costaglioli B, Penna C, Benoist S. Outcome of emergency surgery for severe neuroleptic-induced colitis: results of a prospective cohort. Colorectal Dis 2016; 18:1179-1185. [PMID: 27166739 DOI: 10.1111/codi.13376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/18/2016] [Indexed: 12/14/2022]
Abstract
AIM The study evaluated the outcome of severe acute antipsychotic (neuroleptic) drug related colitis requiring emergency surgery. METHOD From 2009 to 2014, 20 patients underwent emergency surgery for acute and severe neuroleptic-related ischaemic colitis. Neuroleptic-induced colitis was defined as another cause besides inflammatory, infectious or ischaemic colitis with a relationship to treatment by antipsychotic drugs. RESULTS The main drugs involved were cyamemazine (n = 9, 45%), loxapine (n = 5, 25%), haloperidol (n = 4, 20%) and alimemazine (n = 4, 20%). Most (n = 14, 70%) patients presented with haemodynamic instability requiring massive resuscitation and vasopressive drugs. CT signs of digestive impairment were found in 13 (65%) patients having emergency surgery. The lesions were pancolonic in 40%; transparietal necrosis was found in 45% and 15% had colonic perforation. Twelve (60%) patients had total or subtotal colectomy and eight (40%) a segmental colectomy with colostomy or ileostomy in all cases. The postoperative mortality was 15% and morbidity was 70%, necessitating surgical reintervention in two (10%) patients. Of the 17 surviving patients, 11 (64.7%) had restoration of intestinal continuity after a median delay of 103 days, with a postoperative morbidity rate of 36.3%. In the intent-to-treat population, the permanent stoma rate was 30%. CONCLUSION The morbidity and mortality of surgery for neuroleptic-drug-induced colitis is higher than for colitis due to other causes. A better knowledge of this condition should lead to early diagnosis.
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Affiliation(s)
- S Abdalla
- Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - A Brouquet
- Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - T Lazure
- Department of Pathology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - B Costaglioli
- Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - C Penna
- Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France
| | - S Benoist
- Department of Digestive and Oncologic Surgery, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, University Paris-Sud, Le Kremlin-Bicêtre, France
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Peker KD, Cikot M, Bozkurt MA, Ilhan B, Kankaya B, Binboga S, Seyit H, Alis H. Colonoscopic decompression should be used before neostigmine in the treatment of Ogilvie's syndrome. Eur J Trauma Emerg Surg 2016; 43:557-566. [PMID: 27432173 DOI: 10.1007/s00068-016-0709-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/11/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Performance of urgent colonoscopy for the purposes of diagnosis and treatment of Ogilvie's syndrome remains controversial. However, no trials have directly compared neostigmine with endoscopic therapy. This study aimed to compare the effect of neostigmine and colonoscopic decompression in the treatment of Ogilvie's syndrome. METHODS This study was designed as a retrospective, non-randomized clinical study of sequential patients. Patients who were diagnosed as having acute colonic pseudo-obstruction were separated into two groups after conservative treatment. Group 1 comprised patients who underwent colonoscopic decompression, because they had a poor first response to neostigmine treatment. Group 2 constituted patients who had a poor first response to colonoscopic decompression, and neostigmine was added to the treatment regimen. Groups 1 and 2 were compared for the success of disease management. RESULTS In groups 1 and 2, the average age of the patients was 63.19 years (±14.71 years) and 59.45 years (±15.31 years) (p = 0.312), respectively. No significant difference was determined between the groups in terms of distribution of sex, hospital stay, etiologies, and initial cecal sizes in imaging (p > 0.05). Response to first intervention was statistically significant (p < 0.01). Also, the total response was determined statistically significant for hospital stay if colonoscopic decompression was performed (p < 0.01). No recurrence was determined during the 1-month follow-up in both groups. Although there was no etiologic factor for neostigmine response according to univariate analysis results, colonoscopic success was decreased due to age, sex, and the presence of a cardiac disease. CONCLUSIONS Although the success rate of neostigmine treatment was significantly lower in our homogeneous groups, no significant decrease was determined in terms of hospital stay, intensive care unit stay, and requirement of colostomy compared with colonoscopic decompression. By comparison, colonoscopic decompression, which was performed by experienced endoscopists as a first-line treatment option, was more effective as an initial therapy and was more effective at avoiding a second treatment modality.
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Affiliation(s)
- K D Peker
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey.
| | - M Cikot
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - M A Bozkurt
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - B Ilhan
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - B Kankaya
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - S Binboga
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - H Seyit
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
| | - H Alis
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No. 11, Bakirkoy, 34147, Istanbul, Turkey
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