Ogilvie’s syndrome treated with an emergency laparotomy, right hemicolectomy and end ileostomy

Abstract

Acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is a rare clinical entity in which there is massive non-toxic colonic dilatation in the absence of a mechanically obstructing lesion. It is an important yet poorly recognised cause of surgical morbidity and mortality occurring typically in elderly patients with multiple comorbidities. ACPO can often be reversed conservatively with colonoscopic or nasogastric decompression. Surgical intervention is seldom necessary. We present a case of Ogilvie's syndrome in which a healthy 76-year-old man developed life-threatening pseudo-obstruction following rib polytrauma after a mechanical fall. Pneumatosis coli was evident radiologically, prompting emergency exploratory laparotomy. Operative findings of serosal tearing and ischaemic colitis necessitated treatment with right hemicolectomy and ileostomy formation. Microbiological and histopathological analyses proved negative for inflammatory, obstructive and infectious colitides. The case emphasises the importance of early recognition and timely intervention in the management of this rare yet potentially fatal cause of megacolon.

A woman with adult‐onset Still's disease and acute intestinal pseudo‐obstruction

“…5 After excluding mechanical obstruction, assessing the presence of ischemia and perforation, which require surgical treatments, is important. 13 In our patient, the blood pressure was stable, and contrast CT and colon endoscopy examinations disproved any blood flow disturbances or mechanical obstructions in the intestinal tract. Thus, we selected a conservative treatment with infusion, fasting, and intestinal tract decompression.…”

“…Pseudo‐obstruction develops as a complication of various diseases, especially acute ones 5 . After excluding mechanical obstruction, assessing the presence of ischemia and perforation, which require surgical treatments, is important 13 . In our patient, the blood pressure was stable, and contrast CT and colon endoscopy examinations disproved any blood flow disturbances or mechanical obstructions in the intestinal tract.…”

“…Thus, we selected a conservative treatment with infusion, fasting, and intestinal tract decompression. At the same time, we should discontinue drugs that could be causal and promote the treatment for underlying diseases 13 . Erythromycin has been reported to exert an excitomotor effect 14 and would be effective for intestinal pseudo‐obstructions 15 …”

Acute colonic pseudo-obstruction and rapid septic progression after transabdominal preperitoneal hernia repair: a case report

“…Usually, the majority of patients diagnosed with ACPO are successfully managed with conservative measures such as nil per os, a nasogastric tube, erythromycin, and metoclopramide; emergent colonoscopy and surgery are rarely required [ 13 ]. Recently, the effectiveness of neostigmine as an acetylcholinesterase inhibitor to promote bowel movement has been reported [ 14 ].…”

Pneumatosis intestinalis with portal, mesenteric and renal gas due to colonic pseudo-obstruction

“…In severe cases, colonic pseudo-obstruction may lead to perforation or ischemia and is then associated with a high mortality rate [ 5 ]. Treatment options range from medical treatment, endoscopic interventions, or, in case of treatment failure, surgery [ 5 , 6 ].…”