Pseudo-obstruction of the large bowel

Abstract

SUMMARYTweloe episodes of large bowel pseudo-obstruction occurring in I 1 patients are described. The clinical and radiological features are discussed from a diagnostic aspect. The aetiology and treatment of the condition are considered.PSEUDO-OBSTRUCTION denotes apparent intestinal obstruction occurring in the absence of occlusion of the alimentary lumen. It may occur spontaneously, but frequently it is associated with pathology elsewhere in the body. The aetiology is uncertain and the condition presents problems in both diagnosis and management. This paper reports the author's personal experiences with 1 1 patients who presented with the large bowel syndrome in a period of 3+ years. Case reportsCase 1 : An 86-year-old man was admitted as an emergency on 23 February 1969. He lived alone and had been found collapsed and covered with vomit. He was dehydrated, confused and partially blind and had mild Parkinsonism. The abdomen was distended but not tender. Occasional bowel sounds were heard and the rectum was empty.His haemoglobin was 14.2 g/lOO ml. Abdominal X-rays showed many dilated loops of small bowel and a few fluid levels.An enema produced a moderate result. Laparotomy revealed gross distension of the small bowel and of the large bowel as far as the splenic flexure. Beyond this, the colon was collapsed and no mechanical cause for the apparent obstruction could be found. The small bowel was decompressed.Postoperatively the abdominal distension persisted for several weeks. The patient remained very lethargic and died from bronchopneumonia 3 months later. CUSP 2: A 78-year-old bronchitic and hemiplegic man was admitted as an emergency on 22 June 1969 with chronic retention of urine. His bowel habit had always been regular.Investigations showed a blood urea of 68 mg/100 ml and a WBC of 12 O O O /~I~.~ The haemoglobin and electrolytes were within normal limits.Catheter drainage of the bladder was unsatisfactory and the blood urea rose to 196 mg/100 ml 6 days after admission. Gross abdominal distension with generalized tenderness and guarding then developed. Abdominal X-rays showed multiple fluid levels and gross distension of the transverse colon (Fig. I), while gas was absent from the sigmoid colon. Sigmoidoscopic decompression with a flatus tube proved ineffectual. At laparotomy there was moderate distension of the caecum and ascending and transverse colon. The descending colon was collapsed and what was thought to be a carcinoma of the splenic flexure was felt. Caecostomy was performed.At a further laparotomy 23 weeks later the previously felt mass proved to be merely adhesions between the omentum and spleen. No cause for the apparent obstruction was found. The caecostomy closed spontaneously and the patient later had an uneventful prostatectomy. Case 3 : A 60-year-old man was admitted as an emergency on 16 July 1969 with a 24-hour history of severe central abdominal pain and constipation but no vomiting. The abdomen was a little distended. with generalized tenderness, guarding, rebound tenderness and absent ...

Ogilvie's syndrome–acute colonic pseudo-obstruction

“…Inhibition of the parasympathetic nerves arising from the sacral nerve roots results in megacolon that ends at the frontier between the territories served by the vagus and the hypogastric nerves. In addition, hypoperfusion due to a splanchnic low flow state will be predominant at the watershed between the circulation of the superior and inferior mesenteric arteries, the so-called ''Griffiths Zone'' [13,14]. When there is an appearance of ''cut-off'' at the splenic flexure, the addition of water-soluble enteric contrast to the CT scan will usually help to rule out an organic obstruction at the level of the splenic flexure.…”

“…Other authors have proposed a vascular theory to account for ACPO [13,14], based on decreased splanchnic perfusion (hypovolemia, mesenteric vascular disease); hypoperfusion is typically most severe at the frontier between the superior and inferior mesenteric arterial circulation, the so-called Zone of Griffiths, which corresponds to the typical cut-off near the splenic flexure.…”

Acute Pseudoobstruction of the Colon (Ogilvie Syndrome): A Postoperative Complication of Gynecologic Surgery

“…11 This hypothesis is consistent with data demonstrating patients with Ogilvie syndrome have an increased sympathetic drive. 12 Postoperatively, patients with Ogilvie syndrome have symptoms suggestive of obstruction of the colon that are distinct from simple adynamic ileus. The interval from operation to diagnosis of Ogilvie syndrome is typically 3 to 5 days.…”

Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo‐obstruction: A prospective study

“…Acute colonic pseudo‐obstruction (ACPO) is characterized by massive dilatation of the colon in the absence of mechanical obstruction. This form of motility disorder of colon, also known as Ogilvie's syndrome, 1 typically occurs in hospitalized patients with serious illness 2–4 . The approximate risk of colonic perforation is 3%, with mortality as high as 50% 5 …”

“…This form of motility disorder of colon, also known as Ogilvie's syndrome, 1 typically occurs in hospitalized patients with serious illness. [2][3][4] The approximate risk of colonic perforation is 3%, with mortality as high as 50%. 5 Most cases respond to conservative management within 3 days.…”