Ogilvie syndrom

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Ogilvie syndrom

  1. 1. Ogilvie syndrome Case report & paper review 2004/08/02 Ri 林哲生
  2. 2. Case summary 59 y/o female Past history:  Idiopathic liver cirrhosis for 10+ years  PPU (6 year ago)  LVH (07/12 LVEF 91.5%)
  3. 3. Clinical course 03/29 Left femoral neck fracture 03/30 ORIF 05/29 Remove of implant+ debridement 07/07 Abdominal CT: IHD, CBD stones, distended T colon, pneumatosis at cecum 07/10 Intubation 6 trials--> 4C1 07/13 Hypaque study: distal colon not opacified 07/15 Colon fiberoscopy: no definite obstructive
  4. 4. 3 Hr 8 Hr 17 Hr
  5. 5. 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
  6. 6. 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.
  7. 7. 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
  8. 8. 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
  9. 9. Treatment Medical Care  Supportive care (NPO, NG decompression, fluid resuscitation, enema)  neostigmine  Colonoscopic decompression of the colon Surgical Care  Tube cecostomy  Subtotal colectomy
  10. 10. Neostigmine for the treatment ofacute colonic pseudo-obstruction  NEJM 1999; 341 (3):137
  11. 11. 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
  12. 12. 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.
  13. 13. 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
  14. 14. 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.
  15. 15. Ogilvie Syndrome as aPostoperative Complication Arch Surg. 2000;135:682-687
  16. 16. 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
  17. 17. Patients and methods Type of operation Postoperative day of diagnosis of Ogilvie syndrome Interval from diagnosis to resolution or death Treatment
  18. 18. Results
  19. 19. Results
  20. 20. 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)
  21. 21. Thanks for your attention

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