Ogilvie's syndrome following bilateral knee arthroplasty: a case report

Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, is an uncommon but severe postoperative complication of total hip and knee arthroplasty. This syndrome should be borne in mind after arthroplasty surgery. We present a case of this serious postoperative complication and aim to identify the risk factors and alert surgeons to the possibility and appropriate management of Ogilvie's syndrome.     

Ogilvie's syndrome associated with acute cytomegaloviral infection after liver transplantation

Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a rare complication following liver transplantation. We describe two cases in which the onset of Ogilvie's syndrome is strongly temporally associated with acute cytomegaloviral (CMV) infection in immunosuppressed liver transplant recipients. The pseudo-obstruction resolved rapidly in both cases following treatment with intravenous ganciclovir. Acute CMV infection therefore appeared to be causally linked to pathogenesis of Ogilvie's syndrome in these two cases. This association has not been described previously to our knowledge, and should be considered in any transplant patient presenting with Ogilvie's syndrome. Received: 30 July 1998 Revised: 1 August 1999 Accepted: 16 September 1999     

Nimodipine-treated subarachnoid hemorrhage associated with acute pseudo-obstruction of the colon

Nimodipine is being used with increasing frequency in the prevention or treatment of vasospasm due to subarachnoid hemorrhage. Few side effects have been described. An acute pseudo-obstruction of the colon (Ogilvie's syndrome) in a patient treated with an intravenous infusion of nimodipine is reported. The possible relationship between this serious complication and the use of this drug is discussed.     

Diagnosis and treatment of Ogilvie's syndrome after lumbar spinal surgery. Report of three cases.

Three patients who developed Ogilvie's syndrome following lumbar spinal surgery are described. Ogilvie's syndrome, also known as pseudo-obstruction of the colon, is characterized by massive cecal distention without mechanical obstruction. If this condition is not recognized and not promptly treated, it may be complicated by cecal perforation, a life-threatening hazard. The etiology, diagnosis, management, and potential relationship between lumbar spinal surgery and Ogilvie's syndrome are discussed.     

Acute colonic pseudoobstruction: Ogilvie's syndrome

Based on literature and own original clinical data authors conclude that Ogilvie's syndrome is the form of dynamic obstruction of colon due to lesion of retroperitoneal neural nodes, heart failure and intoxication. Ogilvie's syndrome complicates therapeutic and surgical diseases. This syndrome can be manifested with acute abdomen symptoms and at 22% cases may be the cause of surgical treatment. Ogilvie's syndrome is successfully treated with evacuation of intestinal contents, but the risk of recurrence after this treatment is high. Ethiotropic therapy, correction of water-electrolytic balance and tissues oxygenation, administration of acetylcholinesterase inhibitors are the more effective treatment of this syndrome.     

Ogilvie's syndrome after lower extremity arthroplasty.

OBJECTIVE: To alert surgeons who perform arthroplasty to the possibility of acute colonic pseudo-obstruction (Ogilvie's syndrome) after elective orthopedic procedures. To identify possible risk factors and emphasize the need for prompt recognition, careful monitoring and appropriate management so as to reduce morbidity and mortality. DESIGN: A case series. SETTING: A university-affiliated hospital that is a major referral centre for orthopedic surgery. PATIENTS: Four patients who had Ogilvie's syndrome after lower extremity arthroplasty. Of this group, 2 had primary hip arthroplasty, 1 had primary knee arthroplasty and 1 had revision hip arthroplasty. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: In all 4 patients Ogilvie's syndrome was recognized late and required surgical intervention. Two patients died as a result of postoperative complications. CONCLUSIONS: Our case series identified increasing age, immobility and patient-controlled narcotic analgesia as potential risk factors for Ogilvie's syndrome in the postoperative orthopedic patient. Prompt recognition and early consultation with frequent clinical and radiographic monitoring are necessary to avoid colonic perforation and its significant associated death rate.     

Acute colonic pseudo-obstruction (Ogilvie's syndrome) after renal transplantation.

BACKGROUND: Acute colonic pseudo-obstruction (Ogilvie's syndrome) in the immunosuppressed patient is associated with increased morbidity and mortality. Renal transplant recipients possess several comorbidities that increase the risk of acute pseudo-obstruction of the colon. The aims of this study were to present our experience with this syndrome and to evaluate the potentiating factors in these patients. A review of the literature for pseudo-obstruction following renal transplantation is presented. METHODS: Seven patients who developed Ogilvie's syndrome were identified in a retrospective review of 550 kidney-only transplants. Pretransplant data, potential risk factors, presentation, management, and outcome details were retrieved. The medical literature was reviewed using Medline. RESULTS: Seventy-eight patients with Ogilvie's syndrome in the early posttransplant period have been reported. The associated morbidity and mortality was heightened in this immunocompromised population. Obese transplant recipients (body mass index >30 kg/m2) were at significantly increased risk for developing this syndrome. CONCLUSION: A broad armamentarium of treatment options is available, but the key to successful resolution lies in early recognition.     

Acute pseudoobstruction of the colon (Ogilvie syndrome)

Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute distension of the large bowel without distal obstruction. Apart from few idiopathic cases, the syndrome usually is associated with postoperative, posttraumatic or metabolic disorders of extraintestinal origin. Without treatment, increasing distension leads to cecal perforation with a high mortality. Treatment is conservative initially. If decompression by colonoscopy fails, cecostomy or right hemicolectomy are mandatory. The pathophysiologic mechanism of acute colonic pseudoobstruction is unknown. Whether Ogilvie's syndrome is a genuine clinical entity or a complication of associated diseases is still on question.     

Colonic pseudo-obstruction in surgical patients

Colonic pseudo-obstruction (Ogilvie's syndrome) may occur in surgical patients, particularly those who have had orthopedic or blunt trauma, have uremia or diabetes, have complex metabolic or cardiac failure, have metastatic cancer involving the lymph nodes and neural tissue, or are addicted to narcotics. Although a single true cause has not been identified by fulfilling Koch's postulates, the clinical pattern has been recognized in a variety of surgical patients, and this pattern must be distinguished from true obstruction of the colon. Tumor or internal hernia may constitute an obstruction, but the important differential diagnosis of cecal volvulus must be excluded. Ischemic colitis may be confused with Ogilvie's syndrome or may follow it. Gangrene, infarction, and perforation may ensue as colon diameter increases and particularly if cecal distention reaches above 14 cm. This arbitrary number for cecal dilatation should not be awaited before treatment is instituted if signs of devitalization of the gut or peritoneal signs have developed in the patient. Treatment has changed recently with the widespread application of colonoscopy. Endoscopy is helpful in relieving distention but may also be dangerous in the patient with a massively distended colon, particularly at the level of the thin-walled cecum. Colonoscopy also appears to be associated with a high rate of treatment failure and recurrence. Surgical decompression may take the form of cecostomy or may require exteriorization or resection of the colon if infarction has occurred. A series of 12 patients has been presented. The patients were all referred to a single surgeon in a university medical center over a 4 1/2 year period with clinical patterns not suggestive of a common cause but a similar clinical evolution of Ogilvie's syndrome. The prognosis for such patients in whom the complication is recognized early and in whom decompression is performed endoscopically or surgically is encouraging. If recognition is late and particularly if perforation and gangrene result, mortality is nearly 50 percent.     

Adhesion ileus in patient with previous diagnosis of Ogilvie's syndrome

A case of a 72-year-old man with abdominal pain and ileus is reported. Previous surgery for Ogilvie's syndrome had been performed. Despite conservative therapy, the occlusive symptoms worsen. Therefore the patient was submitted to surgery. At laparotomy two abdominal adhesions were found and sectioned. The differential diagnosis between mechanical ileus and pseudoobstruction for neuro-mechanics dissociation (Ogilvie's syndrome) is difficult, particularly in patients with neurodegenerative diseases.     

Ogilvie's syndrome--a case report and review

Ogilvie's syndrome is caused from functional obstruction of the colon without mechanical stenosis and also termed as pseudo-obstruction of the colon. This disease is seen in patient who has other causative distress. The pathogenesis of this rare entity is unknown but it is suspected that there may be an underlying autonomic disturbance which causes non-mechanical obstruction of the colon. Most of the case reports on Ogilvie's syndrome have appeared in European and North American journals but are extremely rare in Japan. Some cases which have been categorized "spastic ileus" may be included in this syndrome. We recently experienced a patient with cerebral infarction who developed non-mechanical obstruction of the colon. This patient was treated successfully with an exploratory laparotomy and sigmoidostomy. It is considered that early diagnosis is an essential part of the initial management of this syndrome. Conservative treatment is indicated for most of the patients but a definitive surgical therapy is occasionally necessary.     

Akute intestinale Kolonpseudoobstruktion 2 Tage nach Versorgung einer pertrochantären Femurfraktur

Acute colonic pseudoobstruction, following traumatic injuries, is a rare diagnosis. Nevertheless it is life threatening, if it is not recognized and treated promptly. We report one case of this so-called Ogilvie's syndrome, which followed fixation of a trochanteric fracture by intramedullary nailing within 2 days. Due to massive acute colonic distension, the patient suffered from respiratory failure. We excluded other intestinal diseases by CT scanning. After conservative colonic decompression, he recovered after 2 days in the intensive care unit. We describe a variable treatment depending on the severity of the colonic atony. Knowledge of Ogilvie's syndrome, or acute colonic pseudoobstruction, is a must for trauma surgeons, since it can occur within a few hours and can lead to dramatic situations.     

Idiopathic dilatation of the large intestine (Ogilvie syndrome--acute pseudo-obstruction)

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by abdominal distention and massive colonic dilatation without any mechanical cause of obstruction. We have reviewed the records of 57 patients, 36 men and 21 women (median age 65.4 y), from 1/1992 to 12/1996, with a colonic pseudo-obstruction, defined as dilatation of at least 10 cm on plain abdominal x-ray. 38 cases (66.5%) followed surgery or trauma and 19 (33.5%) developed symptoms during severe medical illness. 36 cases (63.2%) got i.v. narcotics prior to development of Ogilvie's syndrome. 4 patients underwent conservative treatment alone, 53 patients (93%) had endoscopic decompression with a decompression tube placed in 49 (86%). Due to 2 failures and 2 complications of endoscopic treatment (one ischemic lesion, one perforation; complication rate 3.8%) 4/53 patients had to be operated (7.5%). Clinical success of endoscopic treatment was 88.6% at first attempt and 92.5% at second attempt. General complications tended to be severe, according to the concomitant diseases (morbidity 35%); overall hospital mortality was 21% (12/57). In conclusion, we believe that endoscopic decompression and tube placement is effective and safe for acute colonic pseudo-obstruction not responding to 24 hour conservative treatment.     

Pseudo-colonic obstruction after lumbar spine surgery: a case report

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterised by abdominal distension and massive colonic dilatation without any mechanical cause of obstruction. The pathogenesis remains unknown but likely involves imbalance between sympathetic and parasympathetic colon innervation. This syndrome is well known in orthopaedic surgery, as trauma and orthopaedic surgery have been reported as aetiological factors. Some cases have been reported after cervical discectomy. We report a case of Ogilvie's syndrome after lumbar spine surgery. Medical treatment including parasympathetic agent was unsuccessful and the patient underwent a right colectomy. The pathophysiology and treatment are discussed based on a review of the literature.     

Spinal anesthesia and Ogilvie's syndrome

Ogilvie's syndrome is an uncommon disorder of acute colonic pseudoobstruction that is often associated with concomitant medical disease or psychiatric medication. Therapeutic interventions include cholinesterase inhibitors, colonic decompression, and, in severe cases, surgery. We report a case of functional obstruction that was resolved after spinal anesthesia. The effect of spinal anesthesia on the autonomic control of colonic motility is discussed, and the literature on neuraxial blockade and Ogilvie's syndrome is reviewed.     

Acute pseudo-obstruction of the colon in a kidney-transplanted patient (Ogilvie's syndrome)

Ogilvie's syndrome is an acute massive dilation of the large bowel without organic obstruction. It can occur from a variety of causes and organ failures. We report on the first patient who has developed this syndrome twice, in both cases after kidney transplantation. The world literature concerning the subject is also reviewed. A complete list of all 86 references is available at the authors.     

Acute colonic pseudo-obstruction after caesarean section

A 32-year-old patient developed pseudo-obstruction of the large bowel following elective caesarean section. The association of this rare postoperative complication with anaesthesia is discussed. Pseudo-obstruction of the large bowel (Ogilvie's Syndrome), is characterised by an adynamic mechanically unobstructed bowel which may progress to marked dilatation of the caecum. The reported mortality varies from 14-30% rising to 40-50% if there is caecal perforation. The underlying mechanism is thought to be an imbalance of the autonomic nervous system.     

Neostigmine for the treatment of pediatric acute colonic pseudo-obstruction

Acute colonic pseudo-obstruction (ie, Ogilvie's syndrome) is an uncommon but serious condition in the pediatric population. Definitive management traditionally has consisted of endoscopic decompression. Recent studies have documented the effectiveness of neostigmine as a pharmacologic alternative to mechanical decompression. To date, however, this literature has focused exclusively on the adult population. The authors present the first reported case of the successful administration of neostigmine to treat acute colonic pseudo-obstruction in a child. J Pediatr Surg 37:E28.     

Decompression of the large intestine in Ogilvie's syndrome by a colonoscopically placed long intestinal tube

A technique whereby a long intestinal tube piggy-backed on the colonoscope was placed in the cecum for decomperssion of the large bowel in Ogilvie's syndrome is described. This technique eliminates the need for fluoroscopy as a KUB can easily confirm the placement of the tube. Although the tube can be potentially dragged back out by the colonoscope, we have not found this to be a problem. This technique appears to be safe and effective in the management of colonic pseudo-obstruction. It can be added to the physicians' armamentarium in managing this clinical entity.     

Acute pseudo-obstruction of the colon

Fourteen patients with acute pseudo-obstruction of the colon (Ogilvie's syndrome) were treated over a 16-year period. Ten patients (71.4%) had a recent history of mental illness and were treated with hypnotic and sedative drugs uninterruptedly for many months. The clinical picture and abdominal radiographs on admission to hospital were typical of acute mechanical obstruction of the colon; 1 patient had a perforation of the transverse colon. Obstruction was ruled out by barium enema in 9 patients, by colonoscopy in 3 and by immediate laparotomy in 2. Twelve patients were treated conservatively by nasogastric tube, correction of fluid and electrolyte imbalance, enemas, cessation of all hypnotic and sedative drugs, and decompression of the colon using a rigid rectoscope and rectal tube. There were no complications and no deaths. Ogilvie's syndrome should be suspected in patients with symptoms of large-bowel obstruction whose history discloses intake of hypnotic and sedative drugs. After mechanical obstruction is ruled out, conservative management is indicated. It should include cessation of all psychopharmacological agents and decompression of the colon by rectal intubation or colonoscopy. If conservative measures fail and the caecum increases in size, operative decompression by transverse colostomy rather than cecostomy is indicated.