Background:
Acute colonic pseudo-obstruction is characterized by clinical and radiological evidence of acute large bowel obstruction in the absence of a mechanical cause. The condition usually affects elderly people with underlying co-morbidities, and early recognition and appropriate management are essential to reduce the occurrence of life-threatening complications.

Methods:
A part-systematic review was conducted. This was based on key publications focusing on advances in management.

Results and conclusions:
Although acute colonic dilatation has been suggested to result from a functional imbalance in autonomic nerve supply, there is little direct evidence for this. Other aetiologies derived from the evolving field of neurogastroenterology remain underexplored. The rationale of treatment is to achieve prompt and effective colonic decompression. Initial management includes supportive interventions that may be followed by pharmacological therapy. Controlled clinical trials have shown that the acetylcholinesterase inhibitor neostigmine is an effective treatment with initial response rates of 60–90 per cent; other drugs for use in this area are in evolution. Colonoscopic decompression is successful in approximately 80 per cent of patients, with other minimally invasive strategies continuing to be developed. Surgery has thus become largely limited to those in whom complications occur. A contemporary management algorithm is provided on this basis. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Acute colonic pseudo-obstruction

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.

Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms.

Introduction: Nous rapportons une complication rare suite a une chirurgie lombaire, le syndrome d'Ogilvie, qui se manifeste par une dilatation aigue du colon en l'absence d'obstruction mecanique. Description de cas: Il s'agit d'une patiente obese de 43 ans qui a subi une chirurgie pour hernie discale au niveau de L4-L5. La patiente s'est plaint de distension abdominale persistante et d'une absence de bruits intestinaux. La radiographie simple et l'ultrasonographie ont revele une dilatation massive du colon. Suite a l'aspiration nasogastrique et au retrait de tous les analgesiques, la distension abdominale est disparue progressivement en 3 jours. Conclusion: Seulement trois cas de syndrome d'Ogilvie suite a une chirurgie spinale lombaire ont ete rapportes dans la litterature. Chez notre cas, l'obesite, la constipation chronique et les narcotiques etaient les causes precipitantes les plus probables. Le probleme peut se resoudre avec le traitement conservateur, mais si le diametre coecal continue d'augmenter, il peut etre necessaire de proceder a une colonoscopic ou a une laparatomie afin de prevenir la perforation du colon.

/pdf/ogilvie-s-syndrome-as-a-rare-complication-of-lumbar-disc-437mwy74kt.pdf

Ogilvie's syndrome as a rare complication of lumbar disc surgery.

Post‐cesarean section acute colonic pseudo‐obstruction with spontaneous perforation

Key content: • In acute colonic pseudo-obstruction (Ogilvie’s syndrome) there is an adynamic ileus without mechanical obstruction, characterised by dilatation of the caecum and right colon. • In obstetrics it is usually associated with caesarean section. • Early diagnosis and appropriate treatment are imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. • Conservative and pharmacological therapies are effective in many women, but surgical intervention may be required.

Acute colonic pseudo-obstruction after caesarean section

Ogilvie's Syndrome is defined as acute distension of the colon without any mechanical obstruction. We reported two new cases who underwent surgical treatment and the revision of the literature. Four hundred eight-six cases are described until now. The physiopathology is unknown. The diagnosis is done with abdominal x-ray, barium enema must be used with attention. The more frequent symptoms are nausea, vomiting, diarrhea, and abdominal pain. The perforation of the colon is possible with a diameter of 9-12 cm. The mortality was 11.3% in two hundred ninety patients (59.6%) who underwent conservative treatment. In one hundred ninety-six patients who underwent surgical treatment the mortality was 28.5%. The treatment is conservative, medical or endoscopic. The best surgical treatment is the tube cecostomy.

[Ogilvie's syndrome].

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[Ogilvie's syndrome].