What is Ogilvie Syndrome?
also known as Acute Colonic Pseudo Obstruction is a condition in which there are signs and symptoms of an abdominal obstruction with out the presence of any mechanical obstruction. It is characterized by the inflammation and abnormal dilation of the cecum ( it is a pouch between the ileum and the starting point of the colon in the large intestine) and the right colon. The dilation of the ileum and the colon is more than 10 cm in this condition.
Causes of Ogilvie Syndrome
- It is commonly seen in patients who are severely ill with acute infections, cardiorespiratory failures, serious neurological disorders and metabolic problems. It is thought to be caused by the improper control of the colonic motor impulses by the autonomic nervous system.
- It may also appear post surgeries like total joint replacement or coronary artery bypass surgery.
- Long term use of neuroleptic drugs like anticholinergics or opoid analgesics also contribute to this condition.
- Malignancy is also known to bring about this condition.
Symptoms of the condition
- Abdominal pain.
- Distended abdomen.
- Weight Loss.
- Nausea and Vomiting.
- Altered bowel movement.
- Abdominal cramps.
Treatment of the Ogilvie Syndrome
- The first step in the treatment would involve stopping all orally ingested food. ‘Nil per os’ meaning medically instructing all food taken via mouth to be stopped coupled with nasogastric feeding is absolutely essential to manage the condition.
- The nasogastric tube is also used to suck out air from the large intestine and bowels.
- If the condition is drug induced then the drugs are discontinued.
- A therapy which involves decompression of the colon as in the colonoscopic procedure is used successfully in 70% of the cases.
- The colonic decompression can also be achieved with the help of a drug Neostigmine. This drug is used prior to trying the colonoscopic way of decompression. However, the said drug comes with the risk of inducing bronchospasms.
- If the condition is induced by metabolic disorders it becomes essential to treat the metabolic condition.
- The resultant fluid and elecrolyte imbalances are corrected by administering electrolytes and vitamins intravenously.
The condition is of a serious and emergent nature and comes with the risks of cecal ischemia ( a problem with the blood supply in the blood vessels of the cecum due to a nerve disorder causing damage to the cells in the tissue leading to necrosis) and perforation if not effectively treated. As this condition manifests itself as a co-morbidity in severe illness, the mortality rate, not surprisingly is about 40%. However, in patients with a perfectly functioning bowel this condition has a mortality rate of 15%.