Ogilvie syndrom

1. Ogilvie syndrome
Case report & paper review
2004/08/02 Ri 林哲生

2. Case summary
59 y/o female
Past history:
Idiopathic liver cirrhosis for 10+ years
PPU (6 year ago)
LVH (07/12 LVEF 91.5%)

3. Clinical course
03/29 Left femoral neck fracture
03/30 ORIF
05/29 Remove of implant+ debridement
07/07 Abdominal CT: IHD, CBD stones, distended T
colon, pneumatosis at cecum
07/10 Intubation 6 trials--> 4C1
07/13 Hypaque study: distal colon not opacified
07/15 Colon fiberoscopy: no definite obstructive

4. 3 Hr 8 Hr
17 Hr

5. Clinical course
07/16 Neostigmine X 3 days

07/19 KUB: massive colonic and intestinal gas
07/20 on rectal tube
07/21 remove of rectal tube
07/27 NPO
08/01 NG feeding with Nupep 1500kcal/1500ml

6. Ogilvie syndrome
Acute colonic pseudo-obstruction
Definition
Colonic dilation without mechanical obstruction
s/s: abdominal distension without pain
Plain film: massive colonic dilation, esp. of the
cecum and right colon
If not decompressed the colon, patient risks
perforation, peritonitis, and death.

8. Pathophysiology
not clearly understood
It is thought to result from an imbalance in the
regulation of colonic motor activity by the
autonomic nervous system.
parasympathetic nervous dysfunction

9. Causes
Ogilvie syndrome is usually associated with a recent,
significant medical illness or surgical procedure.
Recent surgery
Severe pulmonary disease
Severe cardiovascular disease
Severe electrolyte disturbance
Severe constipation
Malignancy
Systemic infection
Medications

10. Treatment
Medical Care
Supportive care (NPO, NG decompression, fluid
resuscitation, enema)
neostigmine
Colonoscopic decompression of the colon
Surgical Care
Tube cecostomy
Subtotal colectomy

11. Neostigmine for the treatment of
acute colonic pseudo-obstruction
NEJM 1999; 341 (3):137

12. Patients and Methods
Patient en-roll criteria:
Abdominal distention and radiographic evidence of colonic
dilation (cecal diameter > 10 cm)
had no response to at least 24 hours of conservative
treatment.
Exclusion criteria:
Basal HR < 60 bpm, SBP < 90 mmHg
active bronchospasm
pregnancy
a history of colon cancer or partial colonic resection
active GI bleeding
signs of bowel perforation

13. Patients and methods
Randomly assigned 11 to receive neostigmine (2mg, iv)
and 10 to receive saline.
Assessment of Outcomes
clinical response

prompt evacuation of flatus or stool

a reduction in abdominal distention
measurements of the colon on radiographs
Patients who had no response to the initial injection were
eligible to receive openlabel neostigmine three hours
later.

17. Conclusion & Discussion
The use of neostigmine should be careful in patient
underlying:
bradyarrhythmias
bronchospasm
renal impairment
The effect of neostigmine treatment, compare with
conservative therapy
Colonoscopy
Surgery

18. Discussion
Even though the elimination half-life of neostigmine is
short, most patients had sustained improvement.
Concomitant treatment with neostigmine and the
anticholinergic agent glycopyrrolate has been reported
to diminish the central cholinergic effects of neostigmine
without reducing the increases in colonic motility.

19. Ogilvie Syndrome as a
Postoperative Complication
Arch Surg. 2000;135:682-687

20. Patients and methods
Trauma or operation between 1989 and 1998
Radiographic findings:
colonic distention greater than 8 cm without evidence
of mechanical obstruction
Patients who had small-bowel dilation in addition
to colonic dilation were considered to have a
postoperative ileus and were excluded from the
study

21. Patients and methods
Type of operation
Postoperative day of diagnosis of Ogilvie
syndrome
Interval from diagnosis to resolution or death
Treatment

22. Results

23. Results

24. Results
Conservative treatment (nasogastric tube placement,
fluid resuscitation, and enemas) was successful in 19
patients (53%).
12 of the 13 patients (92%) had successful
decompression of the colon after the initial colonoscopy
The mortality rate
Total=14% (5/36)
Required operative intervention= 60% (3/5)

26. Thanks for your attention