title: The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients.
abstract: BACKGROUND
  Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies.
  
  
  METHODS
  Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded.
  
  
  RESULTS
  Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy.
  
  
  CONCLUSIONS
  Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair.
authors.affiliation: Department of Neurosurgery, University of South Florida, Tampa, Florida, USA. Electronic address: drjanuszewski@gmail.com.
authors.forename: Jacob
authors.initials: J
authors.lastname: Januszewski
authors.affiliation: Department of Orthopedics-Spine Surgery, The Polyclinic, Seattle, Washington, USA.
authors.forename: Sean K
authors.initials: SK
authors.lastname: Keem
authors.affiliation: Department of Neurosurgery, University Medical Center Las Vegas, Las Vegas, Nevada, USA.
authors.forename: William
authors.initials: W
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Beckman
authors.affiliation: Department of Neurological Surgery, University of Pittsburg Medical Center, Wexford, Pennsylvania, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kanter
authors.affiliation: Department of Neurosurgery, Swedish Medical Center, Seattle, Washington, USA.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskuian
authors.affiliation: Division of Neurosurgery, University of California San Diego, San Diego, California, USA.
authors.forename: William
authors.initials: W
authors.lastname: Taylor
authors.affiliation: Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Uribe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000000981:diagnostic imaging / Q000473:pathology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003112:Colonic Pseudo-Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007081:Ileostomy; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D007418:Intestinal Pseudo-Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D007813:Laparotomy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009388:Neostigmine / Q000627:therapeutic use; D009929:Organ Size; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed
chemical_list: D002800:Cholinesterase Inhibitors; D009388:Neostigmine
keywords: Bowel injury; Bowel perforation; Colon perforation; Complication; Ileus; MIS lateral; MIS spine complication; Ogilvie's syndrome; XLIF