There are rare and potentially life-threatening conditions such as Ogilvie syndrome, also called acute colonic pseudo-obstruction (ACPO), which causes severe dilation of the colon without any mechanical obstruction. As a result, the colon becomes unable to contract and move the stool along, causing a buildup of gas and fluid in the bowel. It can cause abdominal pain, nausea, vomiting, constipation, and dehydration. Ogilvie syndrome can lead to complications such as bowel perforation, sepsis, shock, and death if left untreated.
Causes
The exact cause of ogilvie syndrome is unknown, but it is thought to be caused by an imbalance of the nervous system that regulates intestinal motility.
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Especially abdominal, pelvic, or orthopedic surgery
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Infection, trauma, or injury
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Opioids, anticholinergics, antidepressants, or calcium channel blockers
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Low potassium, magnesium, or calcium levels are electrolyte abnormalities
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Diabetes, hypothyroidism, and uremia are metabolic disorders
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Disorders of the nervous system, such as Parkinson's disease, multiple sclerosis, or stroke
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Compression or injury to the spinal cord
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Childbirth or pregnancy
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Chemotherapy or cancer
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Systemic inflammatory response syndrome (SIRS) is a form of sepsis
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Bed rest or advanced age
Symptoms
Ogilvie syndrome is characterized by sudden or gradual abdominal distension, which may be accompanied by:
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Pain or discomfort in the abdomen
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Vomiting or nausea
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Diarrhea or constipation
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Flatulence or bloating
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Weight loss or loss of appetite
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Breathing difficulties or shortness of breath
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Chills or fever
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Confusion or altered mental status
Diagnosis
Using a combination of clinical presentation, medical history, and imaging tests, Ogilvie syndrome is diagnosed. An abdominal x-ray is the most common method of diagnosing ogilvie syndrome, showing a dilated colon with air-fluid levels and no mechanical obstruction. Among the imaging tests that may be performed to confirm the diagnosis or rule out other causes are:
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Ultrasound can detect fluid or masses in the abdomen and show the thickness and movement of the bowel wall
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CT scan, which provides a detailed view of the abdomen and pelvis, and detects complications such as bowel perforation or ischemia
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Using colonoscopy, you can see the colon directly and remove any stool or foreign bodies that may be obstructing it
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A barium enema can reveal the shape and size of the colon and any strictures or diverticula
Treatment
The treatment of ogilvie syndrome depends on the severity of the condition, the underlying cause, and the response to the initial treatment. In general, the treatment aims to decompress the colon, restore normal bowel function, and prevent or treat complications. Options include:
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As part of conservative management, intravenous fluids, electrolyte replacement, nasogastric tube suction, bowel rest, and correction of any underlying conditions or medications that may be causing Ogilvie syndrome are used. In mild to moderate cases of ogilvie syndrome, conservative management is usually the first-line treatment, and can be effective in up to 80% of patients within 2 to 3 days.
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The most common treatment for ogilvie syndrome is pharmacological management, which uses medications that stimulate colonic motility, such as neostigmine, erythromycin, or metoclopramide. As an adjunct to other treatments or for cases that do not respond to conservative management, pharmacological management is usually reserved. In up to 90% of patients who suffer from ogilvie syndrome, neostigmine can quickly and effectively decompress their colon. However, neostigmine can also cause side effects such as bradycardia, hypotension, or bronchospasm, and should be used with caution.
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Endoscopic management: An endoscope is a flexible tube containing a camera and light that is inserted through the anus and advanced into the colon. In addition to removing stool and foreign bodies that may be blocking the colon, the endoscope can reduce pressure and gas in the colon by performing a decompressive colonoscopy. The endoscope can also be used to perform a cecostomy or a colonic stent placement, which can create an artificial opening or a passage in the colon that will allow gas and fluid to drain. When pharmacological management does not work or as a substitute for surgery, endoscopic management is usually considered.
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As part of surgical management, part or all of the colon is removed (colectomy), or a temporary or permanent opening is created in the colon to divert stool (colostomy or ileostomy). Gilvie syndrome is normally treated surgically as a last resort, and surgical management is reserved for cases that have life-threatening complications, such as bowel perforation, ischemia, or sepsis, or whose treatment has failed. An experienced surgeon should perform surgical management since it carries a high risk of morbidity and mortality.
Prevention
You can reduce your risk of Ogilvie syndrome by following some preventive measures, such as:
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Use of medications that may affect bowel motility, such as opioids, anticholinergics, antidepressants, or calcium channel blockers, should be avoided or limited
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Diabetes, hypothyroidism, and electrolyte abnormalities are medical conditions that may predispose to ogilvie syndrome
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Eating a balanced diet rich in fiber and fluids and maintaining a healthy weight
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Regular exercise and avoiding prolonged bed rest or immobility
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If you experience any symptoms of ogilvie syndrome, including abdominal pain, nausea, vomiting, or constipation, seek medical attention immediately.
