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Vanek P, Urban O, Falt P. Percutaneous endoscopic cecostomy for management of Ogilvie's syndrome: a case series and literature review with an update on current guidelines (with video). Surg Endosc 2023; 37:8144-8153. [PMID: 37500922 PMCID: PMC10519870 DOI: 10.1007/s00464-023-10281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Percutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endoscopy were recently published by three major expert societies, all within the last 2 years. PATIENTS AND METHODS We retrospectively identified three consecutive patients who underwent PEC placement at a Czech tertiary referral center between May 2018 and December 2021: all for recurrent ACPO. In addition, we summarized the current guidelines in order to present the latest knowledge related both to the procedure and management approach in patients with ACPO. RESULTS The placement of PEC was successful and resulted in clinical improvement in all cases without any adverse events. CONCLUSION The results of our experience are in line with previous reports and suggest that PEC may become a very useful tool in the armamentarium of modalities utilized to treat ACPO. Furthermore, the availability of guideline resources now offers comprehensive guidance for informed decision-making and the procedural aspects.
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Affiliation(s)
- Petr Vanek
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic.
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic.
| | - Ondrej Urban
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Premysl Falt
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
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Alswiket HM, Elbawab HY, Alrashed AS, Alsahwan AG, Alqarni ST, Alhamoud NM, Albakhit MH. Ogilvie's Syndrome in a 66-Year-Old Man after Diaphragmatic Plication Surgery: A Rare Postoperative Complication. Am J Case Rep 2023; 24:e940971. [PMID: 37635332 PMCID: PMC10468820 DOI: 10.12659/ajcr.940971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/17/2023] [Accepted: 07/11/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Mechanical and functional intestinal obstruction are serious postoperative complications. Acute colonic pseudo-obstruction (Ogilvie's syndrome) is an acute functional obstruction of the large intestine with various causes, including electrolyte disturbances, certain drugs, trauma, hypothyroidism, and, less often, certain procedures, such as abdominal, pelvic, orthopedic, cardiac, and, rarely, thoracic surgeries. It presents with abdominal distension without evidence of mechanical obstruction. This report is of a 66-year-old man with postoperative Ogilvie's syndrome 1 day after diaphragmatic plication surgery CASE REPORT We present a case of a 66-year-old man with no pre-existing chronic diseases who underwent diaphragmatic plication surgery performed to treat symptomatic diaphragmatic eventration, which was associated with chronic colonic dilation. One day after the procedure, the patient experienced hemodynamic instability, abdominal tenderness and distention, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An abdominal CT scan revealed massive colonic dilation with interposition of the splenic flexure into the diaphragm. Consequently, the patient underwent emergency exploratory laparoscopy, which was later converted to upper laparotomy, during which colonic decompression was performed without identifying any evidence of incarceration. Subsequently, colonic decompression was repeated via sigmoidoscopy, and no mechanical obstruction was found. Lastly, medical treatment was effective in improving the patient's condition CONCLUSIONS In this complicated case, identifying the definite diagnosis was challenging due to the unusual presentation. This rare case might contribute to recognizing a new risk factor for postoperative colonic obstruction, which is preoperative colonic dilation. Also, this case has highlighted the importance of promptly diagnosing postoperative Ogilvie's syndrome to prevent large-bowel perforation.
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Affiliation(s)
- Hasan M. Alswiket
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem Y. Elbawab
- Department of General Surgery, Faculty of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali S. Alrashed
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Abdullah G. Alsahwan
- Department of General Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Sadem T. Alqarni
- College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Noof M. Alhamoud
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad H. Albakhit
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Greenwald ML. Pearls Regarding the Surgical Management of Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2023; 66:e228. [PMID: 36825898 DOI: 10.1097/dcr.0000000000002786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Abstract
CASE SUMMARY A 33-year-old man with a history of chronic alcohol use, generalized anxiety disorder, and hypertension presented to the emergency department after a syncopal event. He was admitted to the medical intensive care unit for alcohol withdrawal, requiring intubation and sedation. On hospital day 7, abdominal x-ray image demonstrated a dilated cecum to 12 cm, transverse colon dilation to 7 cm, and decompressed distal colon ( Fig. 1 ). CT scan of the abdomen and pelvis confirmed dilation of the cecum and ascending and transverse colons ( Fig. 2 ). Colonoscopy showed no evidence of distal obstruction, but colonic distension persisted, and he subsequently underwent cecal decompression with an open "blow-hole" cecostomy fully matured at skin level via a small right lower quadrant incision. The nasogastric tube was removed on postoperative day 2, and his diet was slowly advanced. Abdominal x-ray image on postoperative day 5 demonstrated no colonic dilation. He was discharged home on postoperative day 7. The patient re-presented to the hospital 3 months later with cecostomy prolapse. He underwent cecostomy takedown with ileocecectomy via circumstomal incision. He was discharged home on postoperative day 2.
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Affiliation(s)
- Kristen M Westfall
- Department of Colon & Rectal Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan
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Aguiar D, Fracasso T, Lardi C. Fatal Ogilvie’s syndrome after hip surgery and review of the literature. Forensic Sci Med Pathol 2022; 18:170-175. [PMID: 35258784 PMCID: PMC9106643 DOI: 10.1007/s12024-022-00470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
Abstract
Ogilvie’s syndrome refers to a massive dilation of the colon without mechanical obstruction. Although this syndrome is well-known in the clinical literature and may sometimes be encountered as a complication of abdominal, pelvic, or hip surgery, it has only been reported sporadically in the forensic literature. We present the case of a forensic autopsy carried out on a patient whose death was related to cecal necrosis with acute peritonitis due to Ogilvie’s syndrome following hip surgery. This diagnosis was based on clinical data, post-mortem imagery, autopsy findings, histological analysis, post-mortem chemistry, and microbiological analysis. A review of the literature and possible physiopathology of this disease are performed, while focusing on medico-legal perspectives.
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Affiliation(s)
- Diego Aguiar
- University Center of Legal Medicine (CURML), Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Tony Fracasso
- University Center of Legal Medicine (CURML), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Joechle K, Guenzle J, Utzolino S, Fichtner-Feigl S, Kousoulas L. Ogilvie's syndrome-is there a cutoff diameter to proceed with upfront surgery? Langenbecks Arch Surg 2022; 407:1173-1182. [PMID: 35020083 PMCID: PMC9151542 DOI: 10.1007/s00423-021-02407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/08/2021] [Indexed: 11/04/2022]
Abstract
Purpose Although Ogilvie’s syndrome was first described about 70 years ago, its etiology and pathogenesis are still not fully understood. But more importantly, it is also not clear when to approach which therapeutic strategy. Methods Patients who were diagnosed with Ogilvie’s syndrome at our institution in a 17-year time period (2002–2019) were included and retrospectively evaluated regarding different therapeutical strategies: conservative, endoscopic, or surgical. Results The study included 71 patients with 21 patients undergoing conservative therapy, 25 patients undergoing endoscopic therapy, and 25 patients undergoing surgery. However, 38% of patients (n = 8) who were primarily addressed for conservative management failed and had to undergo endoscopy or even surgery. Similarly, 8 patients (32%) with primarily endoscopic treatment had to proceed for surgery. In logistic regression analysis, only a colon diameter ≥ 11 cm (p = 0.01) could predict a lack of therapeutic success by endoscopic treatment. Ninety-day mortality and overall survival were comparable between the groups. Conclusion As conservative and endoscopic management fail in about one-third of patients, a cutoff diameter ≥ 11 cm may be an adequate parameter to evaluate surgical therapy.
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Affiliation(s)
- Katharina Joechle
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Jessica Guenzle
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Stefan Utzolino
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Lampros Kousoulas
- Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
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Gankpé GF, Do L, Rabhi M. Syndrome d'Ogilvie, une complication rare de la chirurgie du canal lombaire étroit: à propos de deux cas et revue de la littérature. Pan Afr Med J 2022; 42:2. [PMID: 35685386 PMCID: PMC9142784 DOI: 10.11604/pamj.2022.42.2.21183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Le syndrome d´Ogilvie est une pseudo-occlusion colique aiguë, caractérisée par une distension colique avec risque de perforation caecale en absence de tout obstacle mécanique. C´est une pathologie très rare après une chirurgie rachidienne. Nous rapportons deux cas enregistrés dans le service de neurochirurgie du CHU de Guadeloupe. Il s´agit d´une femme de 79 ans en surpoids (IMC=27kg/m2) et un homme de 56 ans présentant des lombosciatagies bilatérales mal systématisées avec réduction du périmètre de marche évoluant depuis plusieurs mois chez qui l´IRM lombaire avait révélé un canal lombaire étroit et hernie discale, avaient subi une intervention chirurgicale de décompression par laminectomie lombaire. Ils ont présenté une constipation avec arrêt des matières et gaz 48h après la chirurgie et un ballonnement abdominal. Le scanner abdominal et la radiographie de l´abdomen ont montré une importante distension intestinale sans obstacle faisant évoquer un syndrome d´Ogilvie. Un traitement conservateur avait été suffisant pour traiter ce syndrome et les patients avaient complètement récupéré. Dans la survenue du syndrome d´Ogilvie, la pathologie la plus fréquente pour laquelle le geste chirurgical rachidien est en cause, est la hernie discale lombaire. La présentation clinique est classique avec un arrêt des matières et des gaz, un météorisme abdominal témoignant d´une distension intestinale volumineuse. Le traitement médical conservatoire reste le traitement de choix lorsque le diagnostic est fait tôt.
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Affiliation(s)
- Gbètoho Fortuné Gankpé
- Service de Neurochirurgie, Centre Hospitalier Universitaire Hassan II, Fès, Maroc
- Service de Neurochirurgie, Centre Hospitalier Universitaire, Guadeloupe, France
- Corresponding author: Gbètoho Fortuné Gankpé, Service de Neurochirurgie, Centre Hospitalier Universitaire Hassan II, Fès, Maroc.
| | - Laurent Do
- Service de Neurochirurgie, Centre Hospitalier Universitaire, Guadeloupe, France
| | - Mohammed Rabhi
- Service de Neurochirurgie, Centre Hospitalier Universitaire, Guadeloupe, France
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Formisano V, Cione G, Di Muria A, Di Carlo F, Capasso A, Russo S, Angrisani L. Acute colonic pseudo-obstruction in elderly Report of a case. Ann Ital Chir 2019; 8:S2239253X19030548. [PMID: 31112520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A case of acute colonic obstruction in an elderly patient is presented, with a brief discussion about peculiar aspects to pseudo-obstruction and particularly chronic idiopathic intestinal pseudo-obstruction (CIIP), in which it was classified by pathologists. Clinical and therapeutic implications of this classification are also discussed. In authors'opinion, interesting aspects of the reported case are represented by the acute presentation, without previous symptoms at medical history and above all by the evidence of a recto-sigmoid junction intraoperatively palpable mass, mimicking ring-like neoplastic disease. The preoperative and intraoperative features led surgeons to perform a total colectomy with ileo-rectal anastomosis and high ligation of mesenteric inferior artery, with complete regional lymphectomy according to oncologic standard, but at histological examination the mass revealed to be due to considerable muscular tissue thickening, therefore to a benign condition. These features probably suggest the need of a better clinical and pathological classification of this difficult and still controversial matter, in order to achieve better outcomes and to avoid misdiagnosis and overtreatment. KEY WORDS: Intestinal obstruction, Pseudo-obstruction, Total colectomy.
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9
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Zareian M, Toorenvliet BR, Kaijser J. [Acute colonic pseudo-obstruction after caesarean section; Ogilvie's syndrome]. Ned Tijdschr Geneeskd 2019; 163:D3012. [PMID: 30730690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Acute pseudo-obstruction of the colon - also known as Ogilvie's syndrome - is a rare clinical presentation in obstetrics. The syndrome is seen more often following caesarean section than vaginal delivery. CASE DESCRIPTION We present a 38-year-old primigravida who developed Ogilvie's syndrome following secondary caesarean section. Despite conservative management, due to a caecal dilation of over 12 centimetres and impending perforation of the caecum, a hemicolectomy was necessary. CONCLUSION Ogilvie's syndrome is potentially life-threatening, certainly if perforation of the bowel occurs. Prompt diagnosis and treatment are essential to prevent severe morbidity.
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Affiliation(s)
- Mytra Zareian
- Ikazia Ziekenhuis, afd. Gynaecologie en Verloskunde, Rotterdam
- Contact: M. Zareian
| | | | - Jeroen Kaijser
- Ikazia Ziekenhuis, afd. Gynaecologie en Verloskunde, Rotterdam
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10
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Abstract
Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, refers to pathologic dilation of the colon without underlying mechanical obstruction, occurring primarily in patients with serious comorbidities. Diagnosis of Ogilvie's syndrome is based on clinical and radiologic grounds, and can be treated conservatively or with interventions such as acetylcholinesterase inhibitors (such as neostigmine), decompressive procedures including colonoscopy, and even surgery. Based on our clinical experience we hypothesized that conservative management yields similar, if not superior, results to interventional management. Therefore, we retrospectively examined all patients over the age of 18 with Ogilvie's syndrome who presented to the Medical University of South Carolina (MUSC). The diagnosis of Ogilvie's syndrome was confirmed by clinical criteria, including imaging evidence of colonic dilation ≥9 cm. Patients were divided and analyzed in 2 groups based on management: conservative (observation, rectal tube, nasogastric tube, fluid resuscitation, and correction of electrolytes) and interventional (neostigmine, colonoscopy, and surgery). Use of narcotics in relation to maximal bowel size was also analyzed. Over the 11-year study period (2005-2015), 37 patients with Ogilvie's syndrome were identified. The average age was 67 years and the average maximal bowel diameter was 12.5 cm. Overall, 19 patients (51%) were managed conservatively and 18 (49%) underwent interventional management. There was no significant difference in bowel dilation (12.0 cm vs 13.0 cm; P = .21), comorbidities (based on the Charlson Comorbidity Index (CCI), 3.2 vs 3.4; P = .74), or narcotic use (P = .79) between the conservative and interventional management groups, respectively. Of the 18 patients undergoing interventional management, 11 (61%) had Ogilvie's-syndrome-related complications compared to 4 (21%) of the 19 patients in the conservative management group (P < .01). There was no difference in overall length of stay in the 2 groups. Two patients, one in each group, died from complications unrelated to their Ogilvie's syndrome. We conclude that Ogilvie's syndrome, although uncommon, and typically associated with severe underlying disease, is currently associated with a low inpatient mortality. While interventional management is often alluded to in the literature, we found no evidence that aggressive measures lead to improved outcomes.
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Affiliation(s)
- Magda Haj
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Mona Haj
- Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC
| | - Don C. Rockey
- Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC
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11
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Toevs CC, Mazellan K, Kohr R. Ogilvie's Syndrome or Colonic Pseudo-Obstruction. Am Surg 2017; 83:217-220. [PMID: 28228208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Kyle Mazellan
- Department of Physical Medicine and Rehabilitation The Ohio State University Wexner Medical Center Columbus, Ohio
| | - Roland Kohr
- Terre Haute Regional Hospital Terre Haute, Indiana
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Núñez-García E, Valencia-García LC, Sordo-Mejía R, Kajomovitz-Bialostozky D, Chousleb-Kalach A. [Drug related colonic perforation: Case report]. CIR CIR 2016; 84:65-8. [PMID: 26242822 DOI: 10.1016/j.circir.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 11/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. OBJECTIVE Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. CLINICAL CASE The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. CONCLUSION It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.
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Lee KJ, Jung KW, Myung SJ, Kim HJ, Kim NY, Yoon YH, Sohn CI, Shin JE, Cho YK, Hong SJ, Lee TH, Park KS, Jung HK, Choi CH, Kim GH, Kim JH, Jo YJ, Lee JS, Park HJ. The clinical characteristics of colonic pseudo-obstruction and the factors associated with medical treatment response: a study based on a multicenter database in Korea. J Korean Med Sci 2014; 29:699-703. [PMID: 24851028 PMCID: PMC4024943 DOI: 10.3346/jkms.2014.29.5.699] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 02/26/2014] [Indexed: 12/12/2022] Open
Abstract
Colonic pseudo-obstruction (CPO) is defined as marked colonic distension in the absence of mechanical obstruction. We aimed to investigate the clinical characteristics of CPO and the factors associated with the response to medical treatment by using a multicenter database in Korea. CPO was diagnosed as colonic dilatation without mechanical obstruction by using radiologic and/or endoscopic examinations. Acute CPO occurring in the postoperative period in surgical patients or as a response to an acute illness was excluded. CPO cases were identified in 15 tertiary referral hospitals between 2000 and 2011. The patients' data were retrospectively reviewed and analyzed. In total, 104 patients (53 men; mean age at diagnosis, 47 yr) were identified. Seventy-seven of 104 patients (74%) showed a transition zone on abdominal computed tomography. Sixty of 104 patients (58%) showed poor responses to medical treatment and underwent surgery at the mean follow-up of 7.4 months (0.5-61 months). Younger age at the time of diagnosis, abdominal distension as a chief complaint, and greater cecal diameter were independently associated with the poor responses to medical treatment. These may be risk factors for a poor response to medical treatment.
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Affiliation(s)
- Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jin Kim
- Department of Gastroenterology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Na Young Kim
- Department of Gastroenterology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Hoon Yoon
- Department of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Department of Gastroenterology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung Eun Shin
- Department of Gastroenterology, Dankook University College of Medicine, Cheonan, Korea
| | - Yu Kyung Cho
- Department of Gastroenterology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo Jin Hong
- Department of Gastroenterology, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Soonchunhyang University Hospital, Seoul, Korea
| | - Kyung Sik Park
- Department of Gastroenterology, Keimyung University School of Medicine, Daegu, Korea
| | - Hye-Kyung Jung
- Department of Gastroenterology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chang Hwan Choi
- Department of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Gwang Ha Kim
- Department of Gastroenterology, Pusan National University School of Medicine, Busan, Korea
| | - Jae Hak Kim
- Department of Gastroenterology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yoon Ju Jo
- Department of Gastroenterology, Eulji University School of Medicine, Seoul, Korea
| | - Joon Seong Lee
- Department of Gastroenterology, Soonchunhyang University Hospital, Seoul, Korea
| | - Hyo-Jin Park
- Department of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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14
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Affiliation(s)
- Yutaka Tomizawa
- Department of Medicine, University of Pittsburgh Medical Center, USA
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15
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Yheulon CG, Gagliano RA. Multiple successful emergent peristomal bowel resections under regional anesthesia in a patient with colonic pseudo-obstruction and severe chronic obstructive pulmonary disease. Am Surg 2013; 79:E47-E48. [PMID: 23317608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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16
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Chénier S, Macieira SM, Sylvestre D, Jean D. Chronic intestinal pseudo-obstruction in a horse: a case of myenteric ganglionitis. Can Vet J 2011; 52:419-422. [PMID: 21731098 PMCID: PMC3058658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An 11-year-old Quarter horse mare was presented for recurrent episodes of colic. A chronic intestinal pseudo-obstruction was diagnosed. Medical treatment and surgical resection of the colon were performed but the condition did not improve and the horse was euthanized. Histopathological examination revealed a myenteric ganglionitis of the small intestine and ascending colon.
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Affiliation(s)
- Sonia Chénier
- Laboratoire d'épidémiosurveillance animale du Québec, Institut national de santé animale, ministère de l'Agriculture, des Pêcheries et de l'Alimentation du Québec, 3220, rue Sicotte, St-Hyacinthe, Québec, Canada.
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Descloux A, Forberger J, Metzger U. [What is your diagnosis? Acute colonic pseudoobstruction (Ogilvie syndrome) in hypothyreosis]. Praxis (Bern 1994) 2010; 99:97-98. [PMID: 20087827 DOI: 10.1024/1661-8157/a000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- A Descloux
- Chirurgische Klinik, Triemlispital, Zürich.
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Pesek T, Pesek K, Glumpak Z, Lez C, Zlojtro M. [Acute colonic pseudo-obstruction with complication--case report]. Lijec Vjesn 2010; 132:18-21. [PMID: 20359154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This case report examines the surgical treatment of megacolon and its complications in a 17-year-old male patient. He was examined in the surgical emergency unit because of severe abdominal pain and absence of stool for one week. Detailed history revealed that the patient had difficulties in defecation from the early childhood. Sphincter control was not established by the age of five. During hospitalzation as a child, the diagnosis of congenital megacolon was excluded (pathohistological examination of rectal biopsy material showed normal findings). He was followed-up regulary, had stool every four to five days and few times received laxatives to relieve constipation. The patient was hospitalized at the Department of Abdominal Surgery and primarily treated with conservative methods trying to induce intestinal peristaltics. As the patient's condition worsened, Hartmann's procedure was performed (sigmoid colon resection). Postoperative recovery was successful and after nine months we established colon continuity. The patient reports for check-ups without any difficulty in defecation.
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Kolev N, Tonev A, Ivanov K, Ignatov V. [Ogilvie syndrome (colonic pseudo-obstruction). A case of the practice]. Khirurgiia (Mosk) 2010:37-40. [PMID: 21972694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), is a clinical disorder with the signs, symptoms, and radiographic appearance of an acute large bowel obstruction with no evidence of distal colonic obstruction. The other name of this disease is an acute non-toxic megacolon. The colon may become massively dilated; if not decompressed, the patient risks perforation, peritonitis, and death. The acute state has to be discerned immediatelly and treated adequately. The conservative tactics includes naso-gastric drainage, resustitation the homeostasis and stimulation the colonic peristalsis. The aggressive behavior includes an operative treatment or colonoscopic decompression. Some authors report for considerable rising in the frequency of the cases in postoperative period in some abdominal diseases. That's why they think that Ogilvie syndrome is a postoperative disease. We present a case of the practice-- an operated man with acute colonic pseudo-obstruction (ACPO) involving acute colonic ischaemia with necrosis.
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Abraján-Hernández OI, Castañón-González JA, León-Gutiérrez MA, Tejeda-Huezo B, Sánchez-Hurtado L, Serrano-Cuevas L, Hernández-Ramírez DA. [Ogilvie syndrome. Report of two cases]. Rev Med Inst Mex Seguro Soc 2009; 47:545-548. [PMID: 20550865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Acute colonic pseudo-obstruction or "Ogilvie syndrome (OS)," is a gastrointestinal motility disorder characterized by marked dilatation of the colon in the absence of mechanical obstruction. It occurs most commonly in the postoperative state or with severe medical illness; it has been associated with a wide range of comorbidities, including trauma, pelvic surgery (orthopedic, gynecologic, urologic), metabolic disorders, central nervous system disorders, and prostaglandin abnormalities. OS may also be drug induced or idiopathic. Left untreated, it can progress to perforation, peritonitis, and death. Definitive management of OS traditionally has consisted of mechanical decompression. However, neostigmine, an acetyl-cholinesterase inhibitor, has recently emerged as a safe and effective pharmacologic alternative in the adult population. We present two cases of OS attended in the intensive care unit treated with colonoscopy and cecostomy respectively.
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Affiliation(s)
- Octavio Iván Abraján-Hernández
- Servicio de Terapia Intensiva, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
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Durai R. Colonic pseudo-obstruction. Singapore Med J 2009; 50:237-244. [PMID: 19352564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Colonic pseudo-obstruction is often confused with mechanical intestinal obstruction. It occurs when there is an autonomic imbalance resulting in sympathetic over-activity affecting some part of the colon. The patient is often elderly with numerous comorbidities. Once mechanical obstruction is excluded by contrast enema, the patient should be treated conservatively with nasogastric and flatus tubes for at least 48 hours, and precipitating factors should be treated. When pseudo-obstruction does not settle with waitful watching, prokinetic agents and/or colonoscopic decompression can be tried. When there is a risk of impending perforation of the caecum from massive colonic dilatation and colonic ischaemia, it should be dealt with by caecostomy or hemicolectomy. In spite of available medical and surgical interventions, the outcome remains poor.
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Affiliation(s)
- R Durai
- Department of Surgery, Queen Mary's Hospital, Sidcup DA14 6LT, The United Kingdom.
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Steer D, Essa A, Clarke DL, Thomson SR. Transverse colon tuberculosis presenting as colonic obstruction. S AFR J SURG 2009; 47:31-32. [PMID: 19408384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Zubarovskiĭ IN, Plutakhin KA. [The Ogilvie syndrome after restorative surgery on the large intestine]. Vestn Khir Im I I Grek 2009; 168:71-72. [PMID: 20020639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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24
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Tung CS, Zighelboim I, Gardner MO. Acute colonic pseudoobstruction complicating twin pregnancy: a case report. J Reprod Med 2008; 53:52-54. [PMID: 18251363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Acute colonic pseudoobstruction, or Ogilvie's syndrome, is a rare but serious medical and obstetric complication. When diagnosed early, treatment with expectant management or more invasive decompression is often successful. However, if not recognized promptly or managed appropriately, this condition can be fatal. CASE We present an unusual case of acute colonic pseudoobstruction occurring after management of preterm labor in a monochorionic-diamniotic twin pregnancy at 29 weeks' gestation complicated with twin-twin transfusion syndrome. CONCLUSION Acute colonic pseudoobstruction should be considered in the differential diagnosis in pregnant women who present with abdominal distention and vomiting.
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Affiliation(s)
- Celestine S Tung
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
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25
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Abstract
BACKGROUND Percutaneous endoscopic colostomy (PEC) is an alternative to surgery in selected patients with recurrent sigmoid volvulus, recurrent pseudo-obstruction or severe slow-transit constipation. A percutaneous tube acts as an irrigation or decompressant channel, or as a mode of sigmoidopexy. This prospective study evaluated the safety and efficacy of this procedure at a single tertiary referral centre. METHODS Nineteen patients with recurrent sigmoid volvulus, ten with idiopathic slow-transit constipation and four with pseudo-obstruction underwent PEC. The tube was left in place indefinitely in those with recurrent sigmoid volvulus or constipation, whereas in patients with pseudo-obstruction it was left in place for a variable period of time, depending on symptoms. RESULTS Thirty-five procedures were performed in 33 patients. Three patients developed peritonitis, of whom one died, and ten patients had minor complications. Symptoms resolved in 26 patients. CONCLUSION This large prospective study has confirmed the value of PEC in the treatment of recurrent sigmoid volvulus and pseudo-obstruction in high-risk surgical patients.
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Affiliation(s)
- W Baraza
- Surgical and Anaesthetic Sciences, University of Sheffield, Sheffield, UK.
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Affiliation(s)
- C O Hanemann
- Institute of Biomedical and Clinical Science, Peninsula Medical School, The John Bull Building, Tamar Science Park, Research Way, Plymouth PL6 8BU, UK.
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Abstract
OBJECTIVE Ogilvies syndrome (OS) is a rare condition in obstetrics but occurs most commonly after caesarean section. Mortality rates from OS can be as high as 36-50% when bowel perforation or ischemia develops which highlights the early recognition of this condition. Early diagnosis is therefore essential to prevent serious morbidity and mortality. CONCLUSION We, therefore report a case of OS after caesarean section in which early detection by senior clinicians resulted in successful management of the condition and an excellent outcome.
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Affiliation(s)
- G Srivastava
- Obstetrics and Gynaecology, Hope Hospital, Salford M6 8HD, UK.
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Cowlam S, Watson C, Elltringham M, Bain I, Barrett P, Green S, Yiannakou Y. Percutaneous endoscopic colostomy of the left side of the colon. Gastrointest Endosc 2007; 65:1007-14. [PMID: 17531635 DOI: 10.1016/j.gie.2007.01.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 01/04/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous endoscopic colostomy (PEC) on the left side of the colon is a minimally invasive endoscopic technique, increasingly used to treat lower-GI conditions. OBJECTIVE To evaluate the efficacy and safety of a PEC tube insertion at a single unit. DESIGN Retrospective data collection. SETTING District general and teaching hospital in the United Kingdom. PATIENTS Data collected from patients with lower-GI disorders who had a PEC tube inserted. INTERVENTIONS Data collection. MAIN OUTCOME MEASUREMENTS Incidence of complications and patient outcome. RESULTS Between 2001 and 2005, 31 patients presented for a PEC. Insertion was possible in 27 patients. Indications included functional constipation (n=8), recurrent sigmoid volvulus (n=8), colonic pseudo-obstruction (n=5), and neurologic constipation (n=6). In 22 patients (81%), symptoms were markedly improved after insertion. Sigmoid volvulus did not recur with a PEC tube in place. The mean (standard error of the mean) duration with tubes in situ was 9.5+/-1.6 months. Only 2 patients still had a PEC tube in situ. A total of 77% of patients had episodes of infection. Infective episodes led to tube removal in 44% of the total group. Other complications included buried internal bolster, fecal leakage, and pain. Mortality was high (26%), with 7 deaths: 5 from unrelated causes and 2 deaths from fecal peritonitis. LIMITATIONS This was a retrospective study. A prospective study in our unit is unlikely because of these results. CONCLUSIONS Symptoms were effectively controlled by a PEC tube insertion, and recurrent sigmoid volvulus was prevented. Recurrent complications caused significant morbidity. Infection necessitated tube removal in the majority of patients. Fatal fecal peritonitis occurred in 2 patients. Indiscriminate use of a PEC in the left side of the colon is not recommended. A PEC should only be considered in carefully selected cases.
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Affiliation(s)
- Simon Cowlam
- Department of Medicine, University Hospital of North Durham, North Road, Durham, UK
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Bertolini D, De Saussure P, Chilcott M, Girardin M, Dumonceau JM. Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature. World J Gastroenterol 2007; 13:2255-7. [PMID: 17465514 PMCID: PMC4146857 DOI: 10.3748/wjg.v13.i15.2255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic colostomy (PEC) is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient’s quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.
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Affiliation(s)
- David Bertolini
- Divisions of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest street 24, 1205 Geneva, Switzerland
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Kumar S, Gilliland R. Profuse per rectal bleeding due to erosion of the inferior epigastric artery following a catheter tube caecostomy. Ulster Med J 2007; 76:41. [PMID: 17288306 PMCID: PMC1940286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reverdy D, Gebhart M, Kothonidis K, Gallez J, De Becker D, Liberale G. Pseudo-colonic obstruction after lumbar spine surgery: a case report. Acta Orthop Belg 2006; 72:769-71. [PMID: 17260618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterised by abdominal distension and massive colonic dilatation without any mechanical cause of obstruction. The pathogenesis remains unknown but likely involves imbalance between sympathetic and parasympathetic colon innervation. This syndrome is well known in orthopaedic surgery, as trauma and orthopaedic surgery have been reported as aetiological factors. Some cases have been reported after cervical discectomy. We report a case of Ogilvie's syndrome after lumbar spine surgery. Medical treatment including parasympathetic agent was unsuccessful and the patient underwent a right colectomy. The pathophysiology and treatment are discussed based on a review of the literature.
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Affiliation(s)
- David Reverdy
- Department of Surgery, Jules Bordet Institute, Brussels, Belgium
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Baron TH, Loftus CG. Successful transanal direct percutaneous ileostomy for management of small bowel pseudo-obstruction after subtotal colectomy. Gastrointest Endosc 2006; 64:837-8. [PMID: 17055892 DOI: 10.1016/j.gie.2006.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 04/27/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Todd H Baron
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Abstract
Splenic flexure volvulus in a child with chronic idiopathic intestinal pseudo-obstruction syndrome is extremely rare. Here we present a case report of this unusual condition in a 7-year-old girl. The splenic flexure volvulus was managed by pressure reduction from the cecal antegrade continence enema, after which elective resection of the splenic flexure and primary anastomosis were performed because she had similar attacks during 4 months after the first detorsion. Postoperatively she made an uneventful recovery. Possible factors of pathogenesis and therapeutic measures are discussed.
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Affiliation(s)
- Akinori Osuka
- Department of Pediatric Surgery, Aichi Children's Health and Medical Center, 1-2 Osakada, Morioka-cho, Obu-city, Aichi 474-0031, Japan.
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Abstract
BACKGROUND Percutaneous cecostomy is used to treat recurrent colonic pseudoobstruction or obstipation in children and adults with multiple medical comorbidities. Percutaneous endoscopic cecostomy is a potentially attractive alternative to surgical or fluoroscopic cecostomy placement. A few reports describe percutaneous endoscopic cecostomy for management of these problems in children, whereas there are no large series of percutaneous endoscopic cecostomy in adult patients describing the indications, complications, and outcomes. OBJECTIVE Report our experience with percutaneous endoscopic cecostomy in adults. DESIGN Case series. SETTING Single tertiary referral center in the United States. PATIENTS Five patients with recurrent colonic pseudoobstruction and 2 with chronic refractory constipation. INTERVENTIONS Percutaneous endoscopic cecostomy. RESULTS Eight cases of percutaneous endoscopic cecostomy were performed from May 2001 through October 2005: 6 for colonic pseudoobstruction and 2 for chronic constipation. Seven of 8 cases were successful and resulted in clinical improvement. One patient required surgical removal of the percutaneous endoscopic cecostomy tube at 4 days for fecal spillage resulting in peritonitis despite successful tube placement for chronic constipation. Removal of the cecostomy tube occurred in 3 of 6 cases of pseudoobstruction (the other 3 remain in place). In the other patient with chronic constipation, clinical improvement occurred, but the patient died of underlying illness 21 days after placement. No other serious complications occurred. LIMITATIONS Retrospective, single-center study. CONCLUSIONS Percutaneous endoscopic cecostomy is a viable alternative to surgically or fluoroscopically placed cecostomy in a select group of patients with recurrent colonic pseudoobstruction or chronic intractable constipation.
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Affiliation(s)
- Christopher R Lynch
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Athreya S, Moss J, Urquhart G, Edwards R, Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome--5 year review. Eur J Radiol 2006; 60:91-4. [PMID: 16806783 DOI: 10.1016/j.ejrad.2006.05.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 04/11/2006] [Accepted: 05/24/2006] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Currently self-expanding metallic stents are being used for palliation and acute decompression of colonic obstruction. The aim of this study is to review our experience of using these metallic stents over a 5-year period. MATERIALS AND METHODS Case records of 102 patients who had colorectal stenting between 1998 and 2004 were reviewed retrospectively. The indications for colorectal stenting, efficacy of the procedure in relieving the obstruction, complications and clinical outcome were analysed. RESULTS Ninety-nine patients had malignant disease and in three patients a benign cause of obstruction was demonstrated. All procedures were performed during normal working hours. Stenting was technically successful in 87 patients (85%). A single stent was placed in 80 patients. Seven patients required two stents. Of the successful cases, 67 had stents placed by fluoroscopy alone and 20 by a combined fluoroscopy/endoscopy procedure. Four percent had early complications (within 30 days) which included four perforations. There were late complications (over 30 days) in 9% which included five stent migrations, two blocked stents and one colovesical fistula. Ninety percent (n=76) of the successful patients needed no further radiological or surgical intervention later. Survival ranged from 14 days to 2 years. CONCLUSION Colorectal stenting when technically successful is an effective procedure for both preoperative and palliative decompression of colonic obstruction.
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Affiliation(s)
- S Athreya
- Department of Radiology, Gartnavel General Hospital, Glasgow, UK.
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Abstract
BACKGROUND Intellectually-disabled patients with acute abdominal conditions are susceptible to late diagnosis and adverse outcome due to impaired communication, altered behaviour, neurological impairment, associated congenital anomalies, variable reaction to pain and drugs and various difficulties in perioperative management. The present study aims to present the experience of surgery for acute abdominal conditions in intellectually-disabled patients. Various difficulties encountered during the management are highlighted and measures to overcome these problems are discussed. METHODS A prospective descriptive population study was performed through the prospective collection of data on consecutive intellectually-disabled adults operated for acute abdominal conditions over a 5-year period. Study parameters included demographic details, clinical presentation, diagnostic modalities, operative findings and outcome in terms of morbidity and mortality. RESULTS Of 19 men and three women with a mean age of 28.3 years, anorexia, vomiting, and increasing abdominal distension were the most common presenting features. History of pica was available in 36.4% of patients. Intestinal obstruction, acute appendicitis, volvulus and pseudo-obstruction of the colon were the most frequently encountered conditions. Postoperative morbidity and mortality were 33 and 23%, respectively. CONCLUSION Intellectually-disabled patients demand particular clinical expertise owing to various difficulties inherent to their mental and physical disabilities. Short history, anorexia, vomiting and abdominal distension should make the clinician aware of the possibility of an acute abdominal condition. History of pica should be considered a serious clinical correlate. A high index of clinical suspicion, intensive perioperative care and low threshold for an early operation are recommended to reduce the higher morbidity and mortality figures.
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Affiliation(s)
- Kamran Khalid
- Department of Surgery, King Saud University Unit, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia.
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Einwächter H, Hellerhoff P, Neu B, Prinz C, Schmid R, Meining A. Percutaneous endoscopic colostomy in a patient with chronic intestinal pseudo-obstruction and massive dilation of the colon. Endoscopy 2006; 38:547. [PMID: 16767603 DOI: 10.1055/s-2006-925246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- H Einwächter
- Department of Internal Medicine II, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Uno Y. Introducer method of percutaneous endoscopic cecostomy and antegrade continence enema by use of the Chait Trapdoor cecostomy catheter in patients with adult neurogenic bowel. Gastrointest Endosc 2006; 63:666-73. [PMID: 16564870 DOI: 10.1016/j.gie.2005.12.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 12/17/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous reports on percutaneous endoscopic cecostomy (PEC) for the delivery of antegrade continence enema (ACE) in adults have been presented in the form of case reports. Heretofore the tubes used in the pull method of PEC have been thick bolster catheters. The author performed PEC by using the introducer method (IM) with 10 F Chait Trapdoor cecostomy catheters (CTCC) in adult cases. OBJECTIVE Report author experience with a new method of PEC in adults. DESIGN Case series. SETTING Single institution in Japan. PATIENTS Five patients with bowel obstruction and 15 patients with chronic severe constipation. INTERVENTIONS The interventions were the pull method or IM of PEC and drainage or ACE. In 5 cases, PEC was performed by the pull method with the use of an 18 F to 24 F bolster catheter for decompression of dilated intestine. In 15 patients with chronic constipation, PEC was performed with the IM method using a balloon catheter (11 F or 15 F) and CTCC. ACE was performed every other day. RESULTS PEC was successful and effective (decompression and evacuation) in all patients. In patients with IM of PEC, 5 patients were placed with a 15 F balloon catheter and 10 patients were placed with an 11 F balloon catheter. Immediate bleeding occurred in 1 case. Balloon rupture occurred during the first month or on average at the 1 month period. Nine of 10 patients who had the 11 F catheters were changed to CTCC. The advantages of CTCC were prevention of accidental balloon rupture, decreased leakage and granulation tissue, and ease of exchange compared with bolster catheter. LIMITATIONS Retrospective, single-institution. CONCLUSIONS PEC with IM is a safe and useful method. CTCC is advantageous on a long-term basis for ACE.
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Affiliation(s)
- Yoshiharu Uno
- Digestive Disease Center, Nikko Memorial Hospital, Muroran, Hokkaido 051-8501, Japan
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39
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Baraza R. Re: Acute colonic pseudo obstruction (Ogilvie's syndrome): a case report. East Afr Med J 2006; 83:116. [PMID: 16708885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Khelif K, Scaillon M, Govaerts MJM, Vanderwinden JM, De Laet MH. Bilateral thoracoscopic splanchnicectomy in chronic intestinal pseudo-obstruction: report of two paediatric cases. Gut 2006; 55:293-4. [PMID: 16407389 PMCID: PMC1856507 DOI: 10.1136/gut.2005.082024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Attar A, Kuoch V, Ducreux M, Benamouzig R, Malka D. Simultaneous decompression colonoscopy and radiologic G-tube insertion in a patient with megacolon because of chronic colonic pseudo-obstruction. Gastrointest Endosc 2005; 62:975-6; discussion 976. [PMID: 16301047 DOI: 10.1016/j.gie.2005.06.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 06/08/2005] [Indexed: 12/10/2022]
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42
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Loefler I. P.G. Jani--"acute colonic pseudo obstruction (Ogilvie's syndrome): case report". East Afr Med J 2005; 82:663; author reply 663. [PMID: 16619714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Singh S, Nadgir A, Bryan RM. Post-cesarean section acute colonic pseudo-obstruction with spontaneous perforation. Int J Gynaecol Obstet 2005; 89:144-5. [PMID: 15847880 DOI: 10.1016/j.ijgo.2005.01.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 01/18/2005] [Accepted: 01/18/2005] [Indexed: 12/22/2022]
Affiliation(s)
- S Singh
- Department of Surgery, Friarage Hospital South Tees NHS Trust, Northallerton, North Yorkshire, UK.
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44
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Affiliation(s)
- M D Saunders
- Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington 98195, USA.
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45
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Abstract
Ogilvie's syndrome was first described by Sir Heneage Ogilvie in 1948 and is a rare disorder comprising acute colonic pseudo obstruction (ACPO) with gross dilation of the caecum and right hemicolon (occasionally extending to the rectum) without an anatomic lesion that obstructs the aboral flow of intestinal contents. A sixty five year old female with ACPO, perforation and septic shock is presented. A retrospective confirmation of the diagnosis was made after surgery at which a grossly dilated caecum and colon were seen and a right hemicolectomy carried out. Preoperative radiological investigations had shown a dilated caecum with massive faecal loading of the colon.
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Affiliation(s)
- P G Jani
- Department of Surgery, College of Health Sciences, University of Nairobi, P.O. Box 45640-00100 Nairobi, Kenya
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Timofeev IM. [Ogilvie's syndrome (acute nontoxic megacolon)]. Khirurgiia (Mosk) 2005:66-7. [PMID: 16050044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Carcoforo P, Jorizzo EF, Maestroni U, Soliani G, Bergossi L, Pozza E. A new approach to the cure of the Ogilvie's syndrome. Ann Ital Chir 2005; 76:65-70. [PMID: 16035674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The Authors describe a their own observation of 25 cases of acute colonic pseudo obstruction, better known as "Ogilvie Syndrome" with the objective to demonstrate that an early recognition and prompt appropriate therapy, better if conservative, can reduce the morbidity and the mortality of the Syndrome. The surgical therapy is reserved only to that cases in which the risk of perforation of the cecum represent an absolute indication to intervention.
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Affiliation(s)
- P Carcoforo
- University of Ferrara, General Surgery Department
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Busch FWJ, Hamdorf JM, Carroll CS, Magann EF, Morrison JC. Acute colonic pseudo-obstruction following cesarean delivery. J Miss State Med Assoc 2004; 45:323-6. [PMID: 15624628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Acute colonic pseudo-obstruction remains an uncommon complication in obstetric practice, but when it occurs, it is most frequently noted after cesarean delivery. Acute colonic pseudo-obstruction is characterized by the findings consistent with large bowel obstruction in the absence of a demonstrable mechanical cause as noted in this case report. We report the occurrence of acute colonic pseudo-obstruction post-cesarean delivery in which prompt recognition of impending cecal perforation allowed appropriate management by tube cecostomy. Although acute colonic pseudo-obstruction is uncommon, it is important that obstetric practitioners recognize this clinical entity as the potentially fatal consequences of cecal perforation can be prevented by tube cecostomy.
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Affiliation(s)
- Friedrich W J Busch
- Department of Obstetrics, King Edward Memorial Hospital, Perth, Western Australia
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Martin MJ, Steele SR, Mullenix PS, Noel JM, Weichmann D, Azarow KS. A pilot study using total colonic manometry in the surgical evaluation of pediatric functional colonic obstruction. J Pediatr Surg 2004; 39:352-9; discussion 352-9. [PMID: 15017551 DOI: 10.1016/j.jpedsurg.2003.11.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Total colonic manometry (TCM) can directly measure intraluminal pressures and contractile function of the entire colon. The utility of TCM to guide the surgical management of functional colonic obstruction has not been reported. METHODS Total colonic manometry was performed on all patients referred for surgical evaluation of refractory functional colonic obstruction. Manometric tracings were obtained while fasting, after feeding, and after pharmacologic stimulation. RESULTS Nine patients were referred for refractory colonic obstruction. The mean age was 4.8 years, and the mean duration of follow-up was 29 months. Two patients had functional obstruction after repair of Hirschsprung's disease, and 7 patients had idiopathic functional obstruction. In the idiopathic group, 4 distinct motility patterns were identified: (1) normal colonic motility, (2) dysmotility with massive distension, (3) persistent segmental dysmotility, and (4) global neuropathy/myopathy. Both Hirschsprung's patients showed globally abnormal motility. Surgical management was guided by TCM results. There was significant improvement in bowel function and weight gain after manometry-guided intervention. An unnecessary laparotomy was avoided in 2 patients. CONCLUSIONS TCM can be valuable in deciding the need for and timing of diversion, the extent of resection required, and the suitability of the patient for restoring bowel continuity in refractory functional obstruction.
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Affiliation(s)
- Matthew J Martin
- Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA
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Abstract
BACKGROUND Percutaneous endoscopic colostomy was used successfully to treat 3 patients with chronic intestinal pseudo-obstruction whose symptoms were not controlled by conservative measures. METHODS Percutaneous endoscopic colostomy tubes were placed to allow intermittent decompression of the colon in response to the occurrence of symptoms. The technique and the equipment are the same as for PEG and are described herein. OBSERVATIONS Symptom improvement was observed in 3 patients, and, to date, surgery has been avoided for all. CONCLUSIONS Percutaneous endoscopic colostomy is a safe and effective management option for selected patients with chronic intestinal pseudo-obstruction.
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Affiliation(s)
- Andrew R A Thompson
- Department of Surgery, Royal West Sussex NHS Trust, St. Richards's Hospital, Chichester, West Sussex, United Kingdom
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