UMEM Educational Pearls

Title: What's the diagnosis? Written by John Greenwood, MD

Posted: 4/10/2011 by Haney Mallemat, MD (Updated: 4/11/2011)
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Question

60 y/o male transferred from local rehab facility c/o abdominal pain.

Answer

Ogilvie's syndrome / Acute colonic pseudo-obstruction (ACPO)

Syndrome of decreased GI motility believed to be an autonomic imbalance (specifically, parasympathetic suppression) predominantly in the cecum and right colon. ACPO is also commonly due to narcotic overuse / abuse.

Differential diagnosis:

Mechanical large bowel obstruction
Toxic megacolon / colitis
Ileus

Abdominal XR:

Gaseous distention without fluid levels (UNLIKE obstruction)
Small bowel dilation is typically absent (UNLIKE ileus)
Preserved haustral markings and smooth inner contour (UNLIKE colitis)

Treatment:

Treat underlying cause (e.g., discontinue narcotics)
Neostigmine
Therapeutic Colonoscopy
Surgical decompression (if severe)

References

Fazel A, Verne GN. New solutions to an old problem: Acute colonic pseudo-obstruction. JClin Gastroenterol 2005; Vol 39(1): 17-20.

Ozkurt H, Yilmaz F, et al. Acute colonic pseudo-obstruction (Ogilvie's syndrome): radiologic diagnosis and medical treatment with neostigmine. Report of 4 cases. Am J of Emer Med 2009; Vol 27: 757.e1 - 757e4.