esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
Annular pancreas is an uncommon condition in adults.
The ring formation generally originates from the failure of
normal clockwise rotation of ventral pancreas. First
described by Tiedmann in 1818, its incidence is
1:20,000 population. It has bimodal presentation i.e is seen
either in Infants or in 4th & 5th decade of life.
Drs. Penzler, Ricker, and Ahmad’s CMC Abdominal Imaging Mastery Project: Febr...Sean M. Fox
Dr. Morgan Penzler is an Emergency Medicine Resident and Drs. Raza Ahmad and Ansley Ricker are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Pneumatosis intestinalis
- Gallstone ileus
- Cecal perforation
Intussusception - A Comprehensive PresentationJemie Nnanna
A comprehensive presentation on Intussusception, a major cause of intestinal obstruction which could be fatal if not attended to promptly.
Contains - introduction, Epidemiology, Classification, Pathophysiology, Clinical features, Investigation, Management
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
Fun Functional Gallbladder Disorders: Update on Hypo and Hyperkinetic Gallbla...Patricia Raymond
Functional gallbladder disorder is biliary pain from motility disturbance in the absence of gallstones, sludge, or microcrystal disease. In patients with biliary-type pain and a normal US, the prevalence is 8% men and 21% women. We will review the clinical manifestations, diagnosis, and management of patients with suspected functional gallbladder disorder, and also address current evaluation and management of sphincter of Oddi dysfunction.
Ileal Volvulus Causing Displacement of the Liver: Case Report.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This presentation explains in detail the definition, pathophysiology, signs & symptoms, management, and prognosis of intestinal obstruction, ileus, and volvulus.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Definition
• First described by British surgeon, William Heneage Ogilvie (1948)
• A syndrome characterized by a clinical picture suggestive of mechanical
obstruction in the absence of any demonstrable evidence of such an
obstruction in the intestine.
• On the basis of the clinical presentation, can be divided into acute and chronic
forms.
• Acute colonic pseudo-obstruction also referred to as Ogilvie syndrome
• The colon is massively dilated; If not decompressed, the patient risks perforation,
peritonitis, and death.
• The mortality rate can be as high as 40% when perforation occurs
Coulie B, Camilleri M. Intestinal pseudo-obstruction. Annu Rev Med. 1999. 50:37-55
Ogilvie H. Large-intestine colic due to sympathetic deprivation; a new clinical syndrome. Br Med J. 1948 Oct
9. 2(4579)
4. Whyisthe cecumusuallythe mostdilated?
Laplace’s law
• The intraluminal pressure needed to stretch the wall
of a hollow tube is inversely proportional to its
diameter.
• The caecum, with its larger diameter, requires less
pressure to increase in size and in wall tension.
• As the wall tension of the colon increases, ischemia
with longitudinal splitting of the serosa, herniation of
the mucosa, and perforation
5. Pathophysiology
• The vagus nerve supplies the parasympathetic tone from the upper
gastrointestinal (GI) tract up to the splenic flexure.
• The sacral parasympathetic nerves (S2 to S5) supply the left colon, sigmoid, and
rectum.
• The lower 6 thoracic segments supply the sympathetic tone to the right colon
• The lumbar segments 1-3 supply the left colon.
• Sympathetic stimuli result in the inhibition of bowel motility and the
contraction of sphincters.
6. Pathophysiology
• Exact mechanism is unknown
• Current theories continue to suggest the idea of an imbalance in the
autonomic nervous system.
Possibly due to
• ↑ sympathetic tone
• ↓ parasympathetic tone
• or a combination of both
Manten HD. Pseudo-obstruction. Haubrich WS, Schaffner F, Berk JE eds. Bockus
Gastroenterology. Philadelphia: WB Saunders Co; 1995. Vol 2: 1249-67.
7. Support for ↑ sympathetic tone:
• 1988 study by Lee et al, hypothesized that increased sympathetic tone to
the colon results in the inhibition of colonic motility.
• By using epidural anesthesia to block the splanchnic sympathetics, they
successfully treated several patients ,whose acute colonic psuedo-
obstruction did not respond to conservative management
• One more study in 2005 - supported this hypothesis by using spinal anesthesia
Lee JT, Taylor BM, Singleton BC. Epidural anesthesia for acute pseudo-obstruction of the colon (Ogilvie's syndrome). Dis
Colon Rectum.
1988 Sep. 31(9):686-91.
Mashour GA, Peterfreund RA. Spinal anesthesia and Ogilvie's syndrome. J Clin Anesth. 2005 Mar. 17(2):122-3.
8. Evidence for ↓ parasympathetic tone
• Disruption of the sacral innervation may leave the distal colon atonic, resulting
in a functional obstruction
• This hypothesis is consistent with studies showing a transition between dilated
and collapsed bowel often at or near the splenic flexure
Bachulis BL, Smith PE. Pseudoobstruction of the colon. Am J Surg. 1978 Jul.
136(1):66-72. Christensen J. Intestinal motor physiology. Sleisenger MH, Fordtran JS, eds. Gastrointestinal Disease:
Pathophysiology, Diagnosis,Management.
9. Pathophysiology
• In 1992, Hutchinson et al reported successfully treating 8 of 11 patients
with acute colonic pseudo-obstruction by using the sympathetic
adrenergic blocker guanethidine, followed by the cholinesterase inhibitor
neostigmine.
Hutchinson R, Griffiths C. Acute colonic pseudo-obstruction: a pharmacological approach. Ann R Coll Surg Engl.
1992 Sep. 74(5):364-7
10. Etiology
The 3 most common associations
• Trauma (especially retroperitoneal)
• Serious infection
• Cardiac disease (especially myocardial infarction and congestive heart failure)
12. Epidemiology
• In studies of 13,000 orthopedic and burn patients-prevalence was 0.29%#
• Slightly more prominent in males (M:F 1.5:1)
• A review of more than 400 cases of colonic pseudo-obstruction cases over a period
of 15 years - reported a mean patient age of 56.5 years for females and 59.9 years
for males. $
• Mortality has been documented to be 14% in medically treated patients and 30%
in surgically treated patients.
# Kadesky K, Purdue GF, Hunt JL. Acute pseudo-obstruction in critically ill patients with burns. J Burn Care Rehabil. 1995 Mar-Apr. 16(2
Pt 1):132-5
$ Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986
Mar. 29(3):203-10.
13. Complications
• Can lead to ischemic necrosis in the massively dilated intestinal segments
• Volvulus
• The most serious complication of colonic pseudo-obstruction is
perforation of the cecum.
• The reported incidence of caecal perforation is 3-40%, and the
associated mortality is 40-50%.
• A caecal diameter greater than 14 cm, a delay in colonic decompression,
and advanced age are all predictors of colonic perforation
Dorudi S, Berry AR, Kettlewell MG. Acute colonic pseudo-obstruction. Br J Surg. 1992 Feb. 79(2):99-103. [Medline].
14. Clinical Presentation
• Occurs most commonly in debilitated, hospitalized patients with multiple medical
problems
• Surgical patients –symptoms usually insidious in onset,
an average of 3-5 days postoperatively.
• Abdominal pain (80%)
• Nausea and vomiting (80%)
• Obstipation (40%)
• 40% may have a recent history of flatus or passage of stool
• Fever (37%)
Alwan MH, van Rij AM. Acute colonic pseudo-obstruction. Aust N Z J Surg. 1998 Feb.
68(2):129-32.
15. Physical Examination
• Abdominal distention (90-100%)
• Abdominal tenderness (64%)
• Hypoactive, high pitched, or absent bowel sounds (60%)
• Normal or hyperactive bowel sounds (40%)
• Empty rectum on DRE
• Guarding and rigidity
Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon
Rectum. 1986 Mar. 29(3):203-10.
16. Workup
• Hyponatremia and hypokalemia can be present -signify dehydration.
• Most useful screening test for intestinal pseudo-obstruction is plain abdominal
X-ray
• The transition between dilated and collapsed bowel is usually near the splenic
flexure but can occasionally occur in the distal or sigmoid colon
• Air-fluid levels are only occasionally observed
• small bowel dilatation can occur, when the ileocecal valve is incompetent
• Flexible colonoscopy can differentiate colonic pseudo-obstruction from
mechanical colonic obstruction and can also serve a therapeutic function when
colonic decompression is performed
Grassi R, Cappabianca S, Porto A, et al. Ogilvie's syndrome (acute colonic pseudo-obstruction): review of the literature and report of
6 additional cases. Radiol Med. 2005 Apr. 109(4):370-5.
17.
18. • Abdominal CT scan is very helpful to confirm the diagnosis by
excluding mechanical obstruction and toxic megacolon
19. • Younger age at the time of diagnosis,
• Abdominal distention as a chief complaint,
• Greater caecal diameter
-independently associated with poor responses to medical treatment.
Lee KJ, Jung KW, Myung SJ, et al. The clinical characteristics of colonic pseudo-obstruction and the factors associated
with medical treatment response: a study based on a multicenter database in Korea. J Korean Med Sci. 2014 May. 29
(5):699-703
20. MedicalTreatment
• Conservative therapy:
• NPO
• Decompressive nasogastric tube
• Maintenance IV fluids
• Bowel regimen – scheduled suppositories / enemas
• Discontinue offending agents
• Treatment of infections
• Incentive spirometry and intermittent positive-pressure breathing may
aggravate colonic dilatation and should be avoided if possible.
• Changing the patient’s position in bed may help mobilize intestinal gas.
Manten HD. Pseudo-obstruction. Haubrich WS, Schaffner F, Berk JE eds. Bockus Gastroenterology. Philadelphia: WB Saunders
Co; 1995. Vol 2: 1249-67.
21. Neostigmine
• Neostigmine is effective in treating 85-90%
• Should be administered only in patients without any mechanical colonic obstruction.
• Adverse effects
• salivation, nausea, vomiting, abdominal pain, bradycardia, hypotension, and
bronchospasm.
• Patients should undergo cardiac monitoring, and atropine should be readily available
during the administration.
• A slow infusion may carry a lower risk of bradycardic episodes than an IV bolus does.
Halverson A. Acute colonic pseudoobstruction. Cameron JL, ed. Current Surgical Therapy. 9th ed.
Philadelphia: Mosby-Elsevier; 2008. 192-5.
22. • In a prospective placebo-controlled trial
• Neostigmine infusion was also found to resolve critical illness−related colonic
ileus in intensive care unit (ICU) patients with multiple organ failure.
• In this trial, neostigmine was administered via continuous IV infusion at a dosage
of 0.4-0.8 mg/hr over 24 hours.
van der Spoel JI, Oudemans-van Straaten HM, Stoutenbeek CP, Bosman RJ, Zandstra DF. Neostigmine resolves critical illness-related
colonic ileus in intensive care patients with multiple organ failure--a prospective, double-blind, placebo-controlled trial. Intensive Care
Med. 2001 May.
23. • In 1999, Ponec et al conducted the
first randomized controlled study
using neostigmine.
• Randomly assigned 21 patients to
receive either 2 mg of neostigmine IV
or placebo
Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N
Engl J Med. 1999 Jul 15.
24. Other Medications
• Lactulose or low-dose polyethylene glycol (both of which are nonabsorbable,
nonmetabolized osmotic agents)
• Daily bisacodyl suppositories helpful to induce rectal emptying and prevent
recurrences.
• Erythromycin, a motilin like agent.
• Methylnaltrexone, a peripherally acting opioid antagonist, has been reported to
be effective in a patient on opioids following surgery
Attar A, Lemann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of
chronic constipation. Gut. 1999 Feb. 44(2):226-30.
25. Colonoscopic Decompression
• Documented success rates ranging from 77% to 86% with morbidities of only 0.2-
2%.
• A study report that retrospectively assessed 100 patients over a period of 10
years concluded that colonoscopy is superior to neostigmine and should be
considered first-line therapy.
• Any sign of mucosal ischemia (eg, mucosal ulceration, submucosal hemorrhage,
or friable mucosa with yellow exudates) indicates the need for urgent laparotomy
Tsirline VB, Zemlyak AY, Avery MJ, et al. Colonoscopy is superior to neostigmine in the treatment of Ogilvie's
syndrome. Am J Surg. 2012 Dec. 204(6):849-55; discussion 855.
Fiorito JJ, Schoen RE, Brandt LJ. Pseudo-obstruction associated with colonic ischemia: successful management
with colonoscopic decompression. Am J Gastroenterol. 1991 Oct. 86(10):1472-6.
26. • Mean durations of conservative management ranging from 3 days to 6.5 days
and have reported even longer periods if clinical signs of perforation were absent
and caecal diameters were less than 9 cm
• Analysis of 1027 cases reported in the literature concluded that a nonoperative
approach (including conservative measures and colonoscopic decompression as
the initial therapy of choice) was associated with few complications and high
efficacy.#
• Early recognition and prompt appropriate conservative therapy could lower
morbidity and mortality and can reduce the number of cases requiring surgical
intervention$
# Wegener M, Borsch G. Acute colonic pseudo-obstruction (Ogilvie's syndrome). Presentation of 14 of our own cases and analysis of
1027 cases reported in the literature. Surg Endosc. 1987.
$ Carcoforo P, Jorizzo EF, Maestroni U, Soliani G, Bergossi L, Pozza E. A new approach to the cure of the Ogilvie's syndrome. Ann Ital
Chir. 2005 Jan-Feb
27. SurgicalTreatment
• In cases of acute colonic dilatation without perforation or ischemia, tube
cecostomy should be considered.
• This procedure can be performed via an open, a percutaneous, or a laparoscopic
approach.
• In some patients, this procedure is curative, and the tube may later be removed
without the need for subsequent surgical intervention
• laparotomy is indicated if signs and symptoms of ischemia or perforation are
present or if colonoscopy confirms ischemia
28. Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation
Alexandra M. Limmer , Zackariah Clement 2017 case report