Acute Colonic Pseudo-Obstruction

Abstract

Acute colonic pseudo-obstruction (ACPO) is a functional disorder of the large intestine distinguished by colonic dysmotility resulting in colonic distension in the absence of mechanical obstruction. The underlying pathophysiology of ACPO remains unclear despite technological advances in understanding the physiology of colonic motility, such as spatio-temporal mapping and high-resolution manometry. In many ways, the management of ACPO has remained relatively unchanged for 40 years. Patients with perforation or suspected ischemia undergo operative intervention, while patients without undergo initial conservative management with bowel rest, correction of electrolyte disturbances, and mobilization. Patients who fail conservative management or have prominent cecal dilatation undergo decompression with either neostigmine or colonoscopy. A subset of patients with ACPO will have recurrent symptoms despite endoscopic and medical management. For these patients who are difficult to manage, an underlying colonic functional disorder, such as slow-transit dysmotility or chronic intestinal pseudo-obstruction may be considered. The following review of ACPO aims to provide a concise update of the causes, diagnosis, and management of this emergency surgical condition.

Ogilvie Syndrome and Acute Kidney Injury: A Rare Complication of Cesarean Section and Preeclampsia

“…Furthermore, fever could be caused by malaria, and AKI, presumably due to abdominal sequestration and relative hypovolemia, was interpreted in the context of an HELLP syndrome; to increase the difficulties, platelet count was low, probably due to sepsis, and hemolysis could be both the result of a malaria crisis or HELLP. The overlap and the differences between the four conditions are reported in Table 1 [ 1 , 2 , 3 , 4 , 5 , 8 , 9 ].…”

“…Fever, initially explained by malaria, was indeed a hallmark of the Ogilvie syndrome, since, as the pressure on the intestinal wall increases, there is a translocation of fluids and bacteria up to colonic perforation and peritonitis [ 3 , 4 , 5 ].…”

“…The case herein discussed is a good example of this complexity, and reports on an unusual condition, Ogilvie syndrome or acute colonic pseudo-obstruction (ACPO), that may arise as a complication of surgery, including Caesarean section, and, as in this case, may lead to acute kidney injury (AKI), thus calling for a differential diagnosis with renal involvement in the course of preeclampsia or HELLP syndrome [ 3 , 4 , 5 ].…”

“…Ogilvie syndrome, is characterized by massive dilatation of the cecum, reaching a diameter greater than 10 cm, in the absence of mechanical obstruction [ 3 , 4 , 5 ]. The dilatation may be limited to the caecum or involve other intestinal segments, up to the entire colon [ 3 , 4 , 5 ]. Symptoms are related to abdominal pain and distension, nausea, and vomiting may be of variable severity.…”

“…The incidence is estimated at about 100 cases per 100,000 hospital admissions every year [ 5 ]. The prevalence is higher after the age of 60, however, in women, it occurs at a lower mean age since it shows an incidence peak related to Caesarean sections [ 4 , 5 ].…”