Clinical course 07/16 Neostigmine X 3 days 07/19 KUB: massive colonic and intestinal gas 07/20 on rectal tube 07/21 remove of rectal tube 07/27 NPO 08/01 NG feeding with Nupep 1500kcal/1500ml
Ogilvie syndrome Acute colonic pseudo-obstruction Definition Colonic dilation without mechanical obstruction s/s: abdominal distension without pain Plain film: massive colonic dilation, esp. of the cecum and right colon If not decompressed the colon, patient risks perforation, peritonitis, and death.
Pathophysiology not clearly understood It is thought to result from an imbalance in the regulation of colonic motor activity by the autonomic nervous system. parasympathetic nervous dysfunction
Causes Ogilvie syndrome is usually associated with a recent, significant medical illness or surgical procedure. Recent surgery Severe pulmonary disease Severe cardiovascular disease Severe electrolyte disturbance Severe constipation Malignancy Systemic infection Medications
Treatment Medical Care Supportive care (NPO, NG decompression, fluid resuscitation, enema) neostigmine Colonoscopic decompression of the colon Surgical Care Tube cecostomy Subtotal colectomy
Neostigmine for the treatment ofacute colonic pseudo-obstruction NEJM 1999; 341 (3):137
Patients and Methods Patient en-roll criteria: Abdominal distention and radiographic evidence of colonic dilation (cecal diameter > 10 cm) had no response to at least 24 hours of conservative treatment. Exclusion criteria: Basal HR < 60 bpm, SBP < 90 mmHg active bronchospasm pregnancy a history of colon cancer or partial colonic resection active GI bleeding signs of bowel perforation
Patients and methods Randomly assigned 11 to receive neostigmine (2mg, iv) and 10 to receive saline. Assessment of Outcomes clinical response prompt evacuation of flatus or stool a reduction in abdominal distention measurements of the colon on radiographs Patients who had no response to the initial injection were eligible to receive openlabel neostigmine three hours later.
Conclusion & Discussion The use of neostigmine should be careful in patient underlying: bradyarrhythmias bronchospasm renal impairment The effect of neostigmine treatment, compare with conservative therapy Colonoscopy Surgery
Discussion Even though the elimination half-life of neostigmine is short, most patients had sustained improvement. Concomitant treatment with neostigmine and the anticholinergic agent glycopyrrolate has been reported to diminish the central cholinergic effects of neostigmine without reducing the increases in colonic motility.
Ogilvie Syndrome as aPostoperative Complication Arch Surg. 2000;135:682-687
Patients and methods Trauma or operation between 1989 and 1998 Radiographic findings: colonic distention greater than 8 cm without evidence of mechanical obstruction Patients who had small-bowel dilation in addition to colonic dilation were considered to have a postoperative ileus and were excluded from the study
Patients and methods Type of operation Postoperative day of diagnosis of Ogilvie syndrome Interval from diagnosis to resolution or death Treatment
Results Conservative treatment (nasogastric tube placement, fluid resuscitation, and enemas) was successful in 19 patients (53%). 12 of the 13 patients (92%) had successful decompression of the colon after the initial colonoscopy The mortality rate Total=14% (5/36) Required operative intervention= 60% (3/5)