title: Ogilvie's syndrome-acute colonic pseudo-obstruction.
abstract: Ogilvie's syndrome describes an acute colonic pseudo-obstruction (ACPO) consisting of dilatation of part or all of the colon and rectum without intrinsic or extrinsic mechanical obstruction. It often occurs in debilitated patients. Its pathophysiology is still poorly understood. Since computed tomography (CT) often reveals a sharp transition or "cut-off" between dilated and non-dilated bowel, the possibility of organic colonic obstruction must be excluded. If there are no criteria of gravity, initial treatment should be conservative or pharmacologic using neostigmine; decompression of colonic gas is also a favored treatment in the decision tree, especially when cecal dilatation reaches dimensions that are considered at high risk for perforation. Recurrence is prevented by the use of a multiperforated Faucher rectal tube and oral or colonic administration of polyethylene glycol (PEG) laxative. Alternative therapeutic methods include: epidural anesthesia, needle decompression guided either radiologically or colonoscopically, or percutaneous cecostomy. Surgery should be considered only as a final option if medical treatments fail or if colonic perforation is suspected; surgery may consist of cecostomy or manually-guided transanal pan-colorectal tube decompression at open laparotomy. Surgery is associated with high rates of morbidity and mortality.
authors.affiliation: Service de chirurgie digestive et de colo-proctologie, hospices civils de Lyon, hopital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 09, France; Université Claude-Bernard, Lyon I, 8, avenue Rockefeller, 69374 Lyon cedex 08, France. Electronic address: paulo.pereira@chu-lyon.fr.
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Service de chirurgie digestive et de colo-proctologie, hospices civils de Lyon, hopital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 09, France.
authors.forename: F
authors.initials: F
authors.lastname: Djeudji
authors.affiliation: Service de chirurgie digestive et de colo-proctologie, hospices civils de Lyon, hopital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 09, France.
authors.forename: P
authors.initials: P
authors.lastname: Leduc
authors.affiliation: Service de chirurgie digestive et de colo-proctologie, hospices civils de Lyon, hopital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 09, France.
authors.forename: F
authors.initials: F
authors.lastname: Fanget
authors.affiliation: Service de chirurgie digestive et de colo-proctologie, hospices civils de Lyon, hopital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 09, France; Université Claude-Bernard, Lyon I, 8, avenue Rockefeller, 69374 Lyon cedex 08, France.
authors.forename: X
authors.initials: X
authors.lastname: Barth
mesh_terms: D002408:Catheters, Indwelling; D003082:Colectomy / Q000379:methods; D003112:Colonic Pseudo-Obstruction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003113:Colonoscopy; D019317:Evidence-Based Medicine; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage; D009388:Neostigmine / Q000627:therapeutic use*; D010277:Parasympathomimetics / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D054368:Laxatives; D010277:Parasympathomimetics; D009388:Neostigmine; D011092:Polyethylene Glycols
keywords: Acute colonic pseudo-obstruction syndrome; Cecostomy; Colonic exsufflation; Cut-off; Neostigmine; Ogilvie's syndrome