Acute colonic pseudo-obstruction, or Ogilvie syndrome, is a specific type of colonic dilatation without underlying mechanical or anatomical causes. Traditional intestinal dilatation is limited to the cecum and ascending colon, with the change occurring close to the splenic flexure.
It most frequently affects elderly persons with multiple underlying comorbidities, although it can also occur in otherwise healthy patients after trauma or surgery. It is critical to remember that acute colonic pseudo-obstruction is an exclusion diagnosis and that more prevalent reasons for mechanical or functional intestinal dilatation must be examined.
Epidemiology
Although there may be some underreporting, the incidence of this disease is generally stated to be 100 cases per 100,000 hospitalizations annually. Males appear to have a slightly higher prevalence, but the cause for this is uncertain. At presentation, people are typically 60 years old.
Most patients have many underlying co-morbidities, and the condition is most frequently developed in individuals who are functionally dependent at baseline. Postoperative days three to five are the most common for surgical patients to be diagnosed.
Anatomy
Pathophysiology
It is hypothesized that nitrous oxide, inhibitory neurotransmitters, and vasoactive intestinal peptides have more significant activity than stimulatory neurotransmitters, most notably acetylcholine. It is unknown to what extent intrinsic enteric reflex arcs, pacemaker activity, and independent enteric nervous system malfunction have a role.
The splenic flexure, autonomic parasympathetic efferent innervation passes from the Vagus nerve to the sacral and to S2, and S4 nerve roots, where pathologic distension of the colon typically ends in acute colonic pseudo-obstruction. Wall tension in the colonic mucosa rises correspondingly to the dilation of the cecum and ascending colon and the increase in luminal diameter.
Colonic ischemia, fluid, bacterial translocation, and, ultimately, colonic perforation are caused by this elevated wall stress. The likelihood of intestinal ischemia or perforation is influenced by the length of colonic dilatation and its absolute diameter. Very few perforation incidences have been documented when the cecal diameter is less than 12 cm.
However, data shows a connection between the risk of problems and diameters more significant than 12 cm. With dilatation lasting more than 5 or 6 days, imposing the highest risk and directly impacting death, the duration of acute colonic pseudo-obstruction appears to be the leading cause of perforation or ischemia.
Etiology
Although there is no known cause for acute colonic pseudo-obstruction, several clinical factors have been found that set patients at an elevated risk. There is a substantial correlation between comorbidities, advanced age-related to electrolyte imbalance or polypharmacy, and low underlying functional status or immobility. Older patients hospitalized, even for non-surgical care, are more vulnerable.
Severe infection, non-operative trauma, and admission for cardiovascular disease were all considered predisposing factors in about 10% of cases in a widely referenced retrospective analysis of 400 patients. Although all surgical procedures increase a patient’s risk for ileus to some extent, major orthopedic and obstetric surgeries are more frequently linked to the emergence.
For unknown causes, there seems to be a relation to cesarean procedures. It is crucial to remember that not all people who acquire acute colonic pseudo-obstruction require hospitalization. Older adults who come into the emergency room or other acute care settings from nursing homes or long-term care institutions, those who have just had abdominal surgery, and people with underlying degenerative neurological diseases are also at higher risk.
Genetics
Prognostic Factors
The presence of multiple co-morbidities in the specific patient population and the underlying condition contributing to the development of acute colonic pseudo-obstruction complicate the expected prognosis. After the diagnosis 15% mortality rate is often expected.
Between 3% and 15% of patients develop complicated acute colonic pseudo-obstruction, associated with a significantly worse prognosis and average fatality rates between 30% and 40%. Cecal diameter and length of illness are two factors linked to the emergence of problems.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
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by Modality
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Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK526102/
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Acute colonic pseudo-obstruction, or Ogilvie syndrome, is a specific type of colonic dilatation without underlying mechanical or anatomical causes. Traditional intestinal dilatation is limited to the cecum and ascending colon, with the change occurring close to the splenic flexure.
It most frequently affects elderly persons with multiple underlying comorbidities, although it can also occur in otherwise healthy patients after trauma or surgery. It is critical to remember that acute colonic pseudo-obstruction is an exclusion diagnosis and that more prevalent reasons for mechanical or functional intestinal dilatation must be examined.
Although there may be some underreporting, the incidence of this disease is generally stated to be 100 cases per 100,000 hospitalizations annually. Males appear to have a slightly higher prevalence, but the cause for this is uncertain. At presentation, people are typically 60 years old.
Most patients have many underlying co-morbidities, and the condition is most frequently developed in individuals who are functionally dependent at baseline. Postoperative days three to five are the most common for surgical patients to be diagnosed.
It is hypothesized that nitrous oxide, inhibitory neurotransmitters, and vasoactive intestinal peptides have more significant activity than stimulatory neurotransmitters, most notably acetylcholine. It is unknown to what extent intrinsic enteric reflex arcs, pacemaker activity, and independent enteric nervous system malfunction have a role.
The splenic flexure, autonomic parasympathetic efferent innervation passes from the Vagus nerve to the sacral and to S2, and S4 nerve roots, where pathologic distension of the colon typically ends in acute colonic pseudo-obstruction. Wall tension in the colonic mucosa rises correspondingly to the dilation of the cecum and ascending colon and the increase in luminal diameter.
Colonic ischemia, fluid, bacterial translocation, and, ultimately, colonic perforation are caused by this elevated wall stress. The likelihood of intestinal ischemia or perforation is influenced by the length of colonic dilatation and its absolute diameter. Very few perforation incidences have been documented when the cecal diameter is less than 12 cm.
However, data shows a connection between the risk of problems and diameters more significant than 12 cm. With dilatation lasting more than 5 or 6 days, imposing the highest risk and directly impacting death, the duration of acute colonic pseudo-obstruction appears to be the leading cause of perforation or ischemia.
Although there is no known cause for acute colonic pseudo-obstruction, several clinical factors have been found that set patients at an elevated risk. There is a substantial correlation between comorbidities, advanced age-related to electrolyte imbalance or polypharmacy, and low underlying functional status or immobility. Older patients hospitalized, even for non-surgical care, are more vulnerable.
Severe infection, non-operative trauma, and admission for cardiovascular disease were all considered predisposing factors in about 10% of cases in a widely referenced retrospective analysis of 400 patients. Although all surgical procedures increase a patient’s risk for ileus to some extent, major orthopedic and obstetric surgeries are more frequently linked to the emergence.
For unknown causes, there seems to be a relation to cesarean procedures. It is crucial to remember that not all people who acquire acute colonic pseudo-obstruction require hospitalization. Older adults who come into the emergency room or other acute care settings from nursing homes or long-term care institutions, those who have just had abdominal surgery, and people with underlying degenerative neurological diseases are also at higher risk.
The presence of multiple co-morbidities in the specific patient population and the underlying condition contributing to the development of acute colonic pseudo-obstruction complicate the expected prognosis. After the diagnosis 15% mortality rate is often expected.
Between 3% and 15% of patients develop complicated acute colonic pseudo-obstruction, associated with a significantly worse prognosis and average fatality rates between 30% and 40%. Cecal diameter and length of illness are two factors linked to the emergence of problems.
https://www.ncbi.nlm.nih.gov/books/NBK526102/
medtigo
Ogilvie Syndrome
Updated :
August 22, 2023
Acute colonic pseudo-obstruction, or Ogilvie syndrome, is a specific type of colonic dilatation without underlying mechanical or anatomical causes. Traditional intestinal dilatation is limited to the cecum and ascending colon, with the change occurring close to the splenic flexure.
It most frequently affects elderly persons with multiple underlying comorbidities, although it can also occur in otherwise healthy patients after trauma or surgery. It is critical to remember that acute colonic pseudo-obstruction is an exclusion diagnosis and that more prevalent reasons for mechanical or functional intestinal dilatation must be examined.
Although there may be some underreporting, the incidence of this disease is generally stated to be 100 cases per 100,000 hospitalizations annually. Males appear to have a slightly higher prevalence, but the cause for this is uncertain. At presentation, people are typically 60 years old.
Most patients have many underlying co-morbidities, and the condition is most frequently developed in individuals who are functionally dependent at baseline. Postoperative days three to five are the most common for surgical patients to be diagnosed.
It is hypothesized that nitrous oxide, inhibitory neurotransmitters, and vasoactive intestinal peptides have more significant activity than stimulatory neurotransmitters, most notably acetylcholine. It is unknown to what extent intrinsic enteric reflex arcs, pacemaker activity, and independent enteric nervous system malfunction have a role.
The splenic flexure, autonomic parasympathetic efferent innervation passes from the Vagus nerve to the sacral and to S2, and S4 nerve roots, where pathologic distension of the colon typically ends in acute colonic pseudo-obstruction. Wall tension in the colonic mucosa rises correspondingly to the dilation of the cecum and ascending colon and the increase in luminal diameter.
Colonic ischemia, fluid, bacterial translocation, and, ultimately, colonic perforation are caused by this elevated wall stress. The likelihood of intestinal ischemia or perforation is influenced by the length of colonic dilatation and its absolute diameter. Very few perforation incidences have been documented when the cecal diameter is less than 12 cm.
However, data shows a connection between the risk of problems and diameters more significant than 12 cm. With dilatation lasting more than 5 or 6 days, imposing the highest risk and directly impacting death, the duration of acute colonic pseudo-obstruction appears to be the leading cause of perforation or ischemia.
Although there is no known cause for acute colonic pseudo-obstruction, several clinical factors have been found that set patients at an elevated risk. There is a substantial correlation between comorbidities, advanced age-related to electrolyte imbalance or polypharmacy, and low underlying functional status or immobility. Older patients hospitalized, even for non-surgical care, are more vulnerable.
Severe infection, non-operative trauma, and admission for cardiovascular disease were all considered predisposing factors in about 10% of cases in a widely referenced retrospective analysis of 400 patients. Although all surgical procedures increase a patient’s risk for ileus to some extent, major orthopedic and obstetric surgeries are more frequently linked to the emergence.
For unknown causes, there seems to be a relation to cesarean procedures. It is crucial to remember that not all people who acquire acute colonic pseudo-obstruction require hospitalization. Older adults who come into the emergency room or other acute care settings from nursing homes or long-term care institutions, those who have just had abdominal surgery, and people with underlying degenerative neurological diseases are also at higher risk.
The presence of multiple co-morbidities in the specific patient population and the underlying condition contributing to the development of acute colonic pseudo-obstruction complicate the expected prognosis. After the diagnosis 15% mortality rate is often expected.
Between 3% and 15% of patients develop complicated acute colonic pseudo-obstruction, associated with a significantly worse prognosis and average fatality rates between 30% and 40%. Cecal diameter and length of illness are two factors linked to the emergence of problems.
https://www.ncbi.nlm.nih.gov/books/NBK526102/
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