Ogilvie syndrome is the acute dilation of the colon with an interesting clinical picture: it suggests mechanical obstruction but there is no evidence of such an obstruction.
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Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO) means that the colon is massively dilated. If not treated, there are risks of perforation, peritonitis, and as the worst outcome death.
This is a very serious condition: If perforation occurs the mortality rate can be as high as 40%. That means that after diagnosing, the ACPO must be treated as quickly as possible.
The symptoms of Ogilvie syndrome can vary greatly from one person to another and that stands true for the severity of the condition.
Common symptoms are abdominal swelling and bloating, abdominal pain, nausea, and vomiting.
Abdominal swelling usually takes several days to develop but since the symptoms are different from person to person it can develop in just 24 hours.
If perforation of bowel occurs, that is followed by abdominal pain, fever, and a severe blood infection.
There are several causes of ACPO are there are three of them that are associated most commonly: trauma, infection, and cardiac disease.
Since there is trauma involved, it can appear after surgery but it can also be a consequence of hypothyroidism, neurologic disorders, medications, severe constipation, spinal cord injury, alcohol abuse, and some other conditions that happen rarely.
As we can see, those are very different conditions, so the question is what is common to them, what could be the basic reason for Ogilvie syndrome to appear.
The exact reason is not yet known but the theory is that an imbalance in the autonomic nervous system is behind it. If you think about it, it makes sense. If we exclude trauma, other disorders do have or may have a connection to the autonomic nervous system.
Up to 95% of cases of ACPO are connected with surgical of other medical conditions in hospitalized patients and that's good news because the syndrome can be recognized quickly and they have help on hand.
Some of other conditions associated with the stay in a hospital are cesarean delivery, some types of surgery (cardiothoracic, pelvic, or orthopedic).
Regarding the age, intestinal pseudo-obstruction may occur in any age but it is generally a condition that appeary in elderly patients.
There is no specific therapy for Ogilvie syndrome and options include medications, decompression and surgery.
Supportive therapy may include intravenous fluids to correct electrolyte imbalances, nasogastric suction to limit the amount of air that is swallowed, and inserting a tube into the rectum to help the release of gas and stool.
Bad news is that, generally speaking, the prognosis is not bright.
First and above all, it is related to the underlying medical condition of the patient. Since we are talking about already sick people, the ACPO treatment may put them in even greater body trauma so up to 30% of treated patients die.
Over the years, better diagnostic and faster reaction start to bring that number down, but this remains a very serious condition. ■