Ogilvie Syndrome

What is Ogilvie Syndrome?

Ogilvie syndrome is a medical condition that is known to dilate the colon or intestines without the presence of an actual mechanical obstruction. This affects the peristaltic movement of the bowels and may cause symptoms similar to an actual colon or intestinal obstruction ^[1].

Ogilvie’s syndrome is a rare phenomenon and its other name is Acute Colonic Pseudo Obstruction (ACPO). It was named after Sir William Heneage Ogilvie who first examined this event in 1948. In this disorder, the normal peristalsis of the bowels is disturbed by the dilation of the colon. It may be treated as any other colonic obstruction but further examination will reveal that no physical obstruction in the affected part of the colon is present. This condition is associated with a pre-existing medical condition, trauma or undergoing a surgery, imbalanced electrolytes in the body and cardiac events that have occurred recently ^{[1, 2, 3]}.

Among the 2 sexes, it occurs more commonly in male than in females. It also seen more frequently in the elderly than in any other age groups. This condition can be managed conservatively but can be life-threatening if not treated timely. Other factors that may affect the prognosis are the age of the patient, delay in the decompression of the colon and extent of the dilation of the bowel. Figure 1 shows a CT scan of a person with dilated intestines ^{[1, 2, 3]}.

Figure 1- CT scan of a patient with Ogilvie syndrome
Causes and Risk Factors

The exact mechanism that leads to the development of this syndrome is still under investigation and the list of conditions associated with it is very extensive. The most common ones that is associated with it are congestive heart failure, myocardial infarction, sepsis and pneumonia. Undergoing cardiac, urologic, neurologic, orthopaedic and abdominal surgical procedures may also put an individual at risk ^[4].

Signs and Symptoms

As mentioned before, the presenting signs and symptoms are very similar to other bowel obstruction. There will be distention of the abdomen that may develop slowly over a few days or rapidly occur within 24 hours. Patient may also complain of abdominal pain and experience nausea and vomiting. The distention can produce potentially lethal complications because it may lead decreased blood flow to the colon or even perforation ^{[2, 4, 5]}.

When the bowel becomes perforated, its content will leak into the abdominal cavity and lead into infection. Signs of abdominal infection may include fever, abdominal tenderness, increased white blood count and sepsis. On the other hand, decreased blood flow to the bowel may cause ischemia and lead to tissue death of the affected part of the colon ^{[2, 4, 5]}.

Diagnosis

Health history and physical examination

The patient may report abdominal distention and feeling of being “bloated” to the physician. Health history and physical examination may reveal other symptoms and establish the diagnosis. Differentiating this condition from other intestinal obstruction through the history and physical examination is nearly impossible so the physician may perform other laboratory tests to the patient ^{[4, 5]}.

Imaging studies

Performing an x-ray to the colon of the patient may reveal the distention. It can also show accumulation of air or fluid in the small intestines which is also indicative of the obstruction in the bowel. If air accumulation does not occur in the entire large intestine, a Computed Tomography (CT) scan may be done. It will provide images of the intestinal structures in order to reveal the obstruction or the apparent absence of it ^{[4, 5]}.

Treatment

The Ogilvie Syndrome treatment or management may involve medications, supportive therapy, decompression of the colon and surgery. There are several factors to consider the most appropriate method for the patient such as progression of the disease, overall health of the patient and the status of the bowel. Undergoing conservative treatment must always be considered by the physician because a large number of patients benefit from these ^{[2, 5]}.

Initial part of the management is the assessment of the colon. Any signs of ischemia or perforation must be identified right away. The presence of any of these 2 will require immediate medical attention. If the cause of the syndrome has been identified, the treatment of the cause will resolve the distention of the abdomen ^{[2, 5]}.

Decompression of the colon may be performed but it should be done as a last resort to individuals who failed to respond to other modes of treatment due to the risks of this procedure such as recurrence of the condition and perforation of the bowel ^{[2, 5]}.

If perforation or tissue death of the affected part of the colon have already occurred, the patient may undergo a surgical procedure. Removal of a segment of the colon or subtotal colectomy may be done to prevent life-threatening complications. This option is also dependent on factors such as the condition of the colon and the ability of the patient to recover from the procedure ^{[2, 5]}.

References

1. WebMD. (2015, May 28). Ogilvie syndrome. Retrieved from WebMD: http://www.webmd.com/digestive-disorders/ogilvie-syndrome
2. Willacy, H. (2015, June 23). Ogilvie’s Syndrome. Retrieved from Patient.info: http://patient.info/doctor/ogilvies-syndrome
3. Cagir, B. (2015, December 28). Intestinal Pseudo-Obstruction. Retrieved from Medscape: http://emedicine.medscape.com/article/2162306-overview
4. Remy, P. (2012). Ogilvie syndrome. Retrieved from National Organization for Rare Disorders: http://rarediseases.org/rare-diseases/ogilvie-syndrome/
5. Maloney, N., & Vargas, D. (2005). Acute Intestinal Pseudo-Obstruction (Ogilvie’s Syndrome). Clinics in Colon and Rectal Surgery, 96-101.