Colonic Pseudo-obstruction
Ogilvie Syndrome, Colonic Ileus

General Considerations

• Mimics large bowel obstruction without point of obstruction
• Mostly in those over 60, with a slight male predominance
• Apparently due to autonomic nervous system imbalance leading to a dysfunctional distal colon and colonic ileus similar to Hirschsprung’s disease
• The cecum, having the largest resting diameter to start, is the most easily dilated (Laplace law)
• Can lead to ischemic of bowel and perforation

Clinical Findings

• Usually associated with other serious medical conditions such as trauma (including recent surgery), systemic infection, electrolyte imbalance, malignancy, medications with an anti-cholinergic effect, and cardiovascular disease
• Abdominal pain, distension and tenderness
• Nausea and vomiting
• Obstipation
• Fever
• Bowel sounds can be normal or hyperactive in about 40%

Imaging Findings

• Plain films of the abdomen are the study of choice
• Colon is dilated
• May have multiple, long fluid levels
• The cecum should not exceed 12-15 cm in diameter due to risk of perforation
• CT is helpful in excluding a cause of a large bowel obstruction or perforation

Differential Diagnosis

• Large bowel obstruction
  • No point of obstruction in colonic pseudo-obstruction
• Constipation
• Megacolon
• Mesenteric ischemia

Treatment

• Treat any underlying medical conditions
• Rectal tube decompression
• Colonoscopic decompression
• Medications such as Neostigmine
• Rarely, surgical decompression such as cecostomy

Complications

• Can lead to ischemic of bowel and perforation

Prognosis

• Mortality rates originally reported as high as 50% have fallen with pharmacologic management 

Ogilvie Syndrome. Images are supine and upright radiographs of abdomen which show dilated colon from cecum to rectum with multiple air-fluid levels.
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eMedicine. Ogilvie Syndrome. P Remy, MD; K Kumbum, SL Carpenter and B Holmstrom