Ogilvie's syndrome (acute colonic pseudo-obstruction)

Abstract

Four additional cases of Ogilvie''s syndrome (acute colonic pseudoobstruction), representing the 1st cases described in Italy, are reported. The medical literature concerning the subject is also thoroughly reviewed. Ogilvie''s syndrome is an acute massive dilatation of the large bowel without organic obstruction of the distal colon. Of 351 cases described in the literature to date, 88% of cases were associated with various extracolonic affections (metabolic and organ dysfunctions, postoperative and posttraumatic states, etc.); 12% of cases were not associated with known disorders and were defined as idiopathic. The pathophysiology of the syndrome is still unknown. Ogilvie, who first described the syndrome in1948, suggested an imbalance between the sympathetic and parasympathetic innervation of the colon: this neurogenic hypothesis has been shared by other authors, although explanations may differ slightly. The clinical and radiologic picture closely resembles mechanical obstruction of the large bowel. The most marked dilatation usually takes place in the right colon and cecum: if the distended cecum reaches a diameter > 9-12 cm, perforation is likely to occur; if perforation occurs, the mortality rate increases from 25-31% to .apprx. 43-46%. If conservative management fails to control the dilatation and cecal rupture is impending or suspected emergency surgery is indicated, the surgical procedure of choice is dictated by the general conditions of the patients, as well as by the intestinal findings: operation may consist of cecostomy, colostomy or right hemicolectomy or simply emptying the bowel.