title: [Treatment of acute colonic pseudo-obstruction (Ogilvie's Syndrome). Systematic review].
abstract: BACKGROUND
  Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review.
  
  
  OBJECTIVE
  Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications.
  
  
  METHODS
  An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012.
  
  
  RESULTS
  Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose (evidence level 2, grade recommendation B). Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt , a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% (level evidence 4, recommendation grade C). PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression (evidence level 2, recommendation grade B). The cecostomy is more effective and safer than conventional colostomy (level of evidence 4, recommendation grade C). The cecostomy is highly effective in colonic decompression but associated with a high mortality (level of evidence 4, recommendation grade C).
  
  
  CONCLUSIONS
  Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression.
authors.forename: Hazem
authors.initials: H
authors.lastname: Ben Ameur
authors.forename: Salah
authors.initials: S
authors.lastname: Boujelbene
authors.forename: Mohamed Issam
authors.initials: MI
authors.lastname: Beyrouti
mesh_terms: D000208:Acute Disease; D002431:Cecostomy / Q000706:statistics & numerical data; D003112:Colonic Pseudo-Obstruction / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D003113:Colonoscopy / Q000706:statistics & numerical data; D004724:Endoscopy / Q000706:statistics & numerical data; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome