Post on 03-Jun-2015
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OGILVIE’S SYNDROME
DR.SOBIA AKRAM KHAWAJA,
MBBS,FCPS,MRCS
DEPARTMENT OF SURGERY
INTERNATIONAL MEDICAL CENTRE
21st NOVEMBER 2012
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DEFINITION:
• Ogilvie syndrome is the acute pseudo obstruction and dilation of the colon in the absence of any mechanical obstruction in severely ill patients
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CHARECTARISTICS
• Colonic pseudo-obstruction is characterized by massive dilatation of the cecum (diameter > 10 cm) and right colon on abdominal X-ray.
• It is a type of megacolon, sometimes referred to as "acute megacolon," to distinguish it from toxic megacolon.
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BACKGROUND
The condition carries the
name of the British surgeon
Sir William Heneage Ogilvie
(1887–1971), who first
reported it in 1948
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ETIOLOGYAFTER SURGERY
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ETIOLOGYBEDRIDDEN
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ETIOLOGY
NEUROLOGICAL DISORDERSCARDIO RESPIRATORY INSUFFICIENCY
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ETIOLOGYMETABOLIC DISTURBANCES
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ETIOLOGY
SEVERE CONSTIPATION
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ETIOLOGY
MALIGNANCY
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ETIOLOGY
SYSTEMIC INFECTION
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ETIOLOGY
DRUGS THAT DISTURB COLONIC MOTILITY (e.g.,anticholinergics or opioid analgesics)
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PATHOPHYSIOLOGY
• The exact mechanism behind the acute colonic pseudo-obstruction is not known.
• The probable explanation is imbalance in the regulation of colonic motor activity by the autonomic nervous system
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PATHOPHYSIOLOGY
• Acute megacolon develops because of abnormal intestinal motility.
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PATHOPHYSIOLOGY
• Acute megacolon can also lead to ischemic necrosis in massively dilated intestinal segments. This is explained by Pascal's principle and Laplaces's law
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EPEDEMIOLOGY
• FREQUENCY• RACE• SEX• AGE
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SIGNS AND SYMPTOMSABDOMINAL DISTENSION
ABDOMINAL PAIN
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SIGNS AND SYMPTOMS
ALTERED BOWEL MOVEMENTS NAUSEA AND VOMITING
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SIGNS AND SYMPTOMS
FEVER
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DIFFERENTIAL DIAGNOSIS
• MESENTERIC ISCHEMIA• COLON CANCER• COLONIC OBSTRUCTION• CONSTIPATION• DIVERTICULITIS• HIRSCHPRUNGS
DISEASE• MEGACOLON• PSEUDOMEMBRANOUS
COLITIS• INTESTINAL
PERFORATION
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COMPLICATIONS
Ogilvie's syndrome may precipitate :
Volvulus.
Perforation
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INVESTIGATIONS ABDOMINAL X-RAY MISCELLANEOUS
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TREATMENT
• It usually resolves with conservative therapy stopping oral ingestions, i.e. nil per os and a nasogastric tube, but may require colonoscopic decompression which is successful in 70% of the cases.
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TREATMENT
• A study published in the New England Journal of Medicine showed that neostigmine is a potent pharmacological way of decompressing the colon.
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TREATMENT
• According to the American Society for Gastrointestinal Endoscopy (ASGE), it should be considered prior to colonoscopic decompression.
• The use of neostigmine is not without risk since it can induce bradyarrhythmia and bronchospasms.
• Therefore atropine should be within immediate reach when this therapy is used
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TREATMENT
ENEMA THERAPY
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SURGICAL CARETUBE CECOSTOMY
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SURGICAL CARESUBTOTAL COLECTOMY
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FOLLOW UP
INPATIENT
CARE
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FOLLOW UP
OUT PATIENT
CARE
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PROGNOSIS
• It is a serious medical disorder and the mortality rate can be as high as 30%.
• Drug induced mega colon has been associated with mortality as high as 27.5%
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PATIENT EDUCATION
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