eMedicine Specialties > Gastroenterology > Colon

Ogilvie Syndrome

Author: Prospere Remy, MD, Assistant Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Internal Medicine, Bronx-Lebanon Hospital Center
Coauthor(s): Kavita Kumbum, MD, Fellow, Division of Gastroenterology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine; Steven Carpenter, MD, Chair, Program Director, Department of Internal Medicine, Memorial Health University Medical Center; Bjorn Holmstrom, MD, Assistant Professor, Department of Internal Medicine, University of South Florida
Contributor Information and Disclosures

Updated: Jul 30, 2008

Introduction

Background

Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), is a clinical disorder with the signs, symptoms, and radiographic appearance of an acute large bowel obstruction with no evidence of distal colonic obstruction. The colon may become massively dilated; if not decompressed, the patient risks perforation, peritonitis, and death.

In 1948, Ogilvie described 2 patients with metastatic cancer and retroperitoneal spread to the celiac plexus. The patients also had signs and symptoms of colonic obstruction but with no evidence of organic obstruction to the intestinal flow. Ogilvie hypothesized that the etiology of their conditions was an imbalance in the autonomic nervous system with sympathetic deprivation to the colon, leading to unopposed parasympathetic tone and regional contraction, with resulting functional obstruction.

In 1958, Dudley et al used the term pseudo-obstruction to describe the clinical appearance of a mechanical obstruction with no evidence of organic disease during laparotomy.

Pathophysiology

The pathophysiology of Ogilvie syndrome is not clearly understood. Research into the neurophysiology of the colon reveals that Ogilvie's hypothesis was close to the proposed current understanding. The parasympathetic nervous system promotes gut motility. The vagus nerve supplies the parasympathetic tone from the upper GI tract to the splenic flexure, and the sacral parasympathetic nerves (S2 to S5) supply the left colon and the rectum. Sympathetic stimuli result in the inhibition of bowel motility and the contraction of sphincters. The lower 6 thoracic segments supply the sympathetic tone to the right colon, while lumbar segments 1-3 supply the left colon.

An imbalance in the autonomic innervation appears to lead to a functional bowel obstruction, as supported by pharmacologic and spinal blockade studies, metabolic abnormalities, and retroperitoneal trauma. Unlike Ogilvie's hypothesis, some current evidence suggests that an interruption of the sacral parasympathetic nerves occurs, leading to an adynamic distal colon that is similar to Hirschsprung disease, except with normal ganglion cells observable on autopsy. Other research supports the belief that the sympathetic tone increases in these patients, who are usually very ill, leading to inhibition of colonic motility.

The cecum is the usual site of the largest dilatation in patients with Ogilvie syndrome and, thus, is more prone to the risk of perforation. The Laplace law indicates that the intraluminal pressure needed to stretch the wall of a hollow tube is inversely proportional to its diameter. The cecum, with its larger diameter, requires the smallest amount of 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 can occur.

Frequency

United States

The frequency has not been established.

International

This rare clinical condition makes it difficult to gather solid epidemiological studies, particularly in regard to its frequency.

Mortality/Morbidity

Mortality rates of 15-50% have been reported; however, with increased awareness, better diagnostic tools, and prompt management of this disorder, mortality rates have decreased. The risk of perforation is higher with a larger cecal diameter. Generally, the overall medical status of patients with Ogilvie syndrome is poor. The prognosis in patients successfully treated for this disorder is directly related to the severity of the co-occurring medical conditions.

Race

No data suggest a different frequency according to race.

Sex

No convincing data suggest a different frequency according to sex; however, some researchers suggest that this illness may have a slight male predominance, possibly by a ratio of 1.5:1.

Age

Ogilvie syndrome is generally a disease of elderly patients, usually older than 60 years; however, this disorder may occur in younger patients, particularly those with underlying spinal cord disorders.

Clinical

History

Patients with Ogilvie syndrome present with abdominal distention and generally have obstipation. Up to 40% may have a recent history of flatus or passage of stool. Presenting symptoms are as follows:

  • Abdominal pain (80%)
  • Nausea and vomiting (80%)
  • Obstipation (40%)
  • Fever (37%)

Physical

  • Abdominal distention (90-100%)
  • Abdominal tenderness (64%)
  • Bowel sounds
    • Normal or hyperactive (40%)
    • Hypoactive, high pitched, or absent (60%)

Causes

Ogilvie syndrome usually occurs in a setting of a recent serious medical illness or surgical procedure. The 3 most common associations are trauma, infection, and cardiac disease, especially myocardial infarction and congestive heart failure. 

More on Ogilvie Syndrome

Overview: Ogilvie Syndrome
Differential Diagnoses & Workup: Ogilvie Syndrome
Treatment & Medication: Ogilvie Syndrome
Follow-up: Ogilvie Syndrome
References
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References

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  32. Turegano-Fuentes F, Munoz-Jimenez F, Del Valle-Hernandez E, et al. Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment. Dis Colon Rectum. Nov 1997;40(11):1353-7. [Medline].

  33. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum. Mar 1986;29(3):203-10. [Medline].

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Further Reading

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Keywords

Ogilvie syndrome, Ogilvie's syndrome, acute colonic pseudo-obstruction, ACPO, colonic pseudoobstruction, bowel obstruction, colonic obstruction, acute large bowel obstruction, colonic perforation, intestinal perforation, peritonitis, nontoxic megacolon, bowel motility, adynamic distal colon, Hirschsprung disease, abdominal distention, obstipation, cecal perforation, cecostomy, colonoscopy, colonoscopic decompression, colectomy

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Contributor Information and Disclosures

Author

Prospere Remy, MD, Assistant Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Internal Medicine, Bronx-Lebanon Hospital Center
Prospere Remy, MD is a member of the following medical societies: American College of Physicians and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Coauthor(s)

Kavita Kumbum, MD, Fellow, Division of Gastroenterology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine
Kavita Kumbum, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Steven Carpenter, MD, Chair, Program Director, Department of Internal Medicine, Memorial Health University Medical Center
Steven Carpenter, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Bjorn Holmstrom, MD, Assistant Professor, Department of Internal Medicine, University of South Florida
Bjorn Holmstrom, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, Medical Association of Georgia, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Heuman, MD, FACP, Director of Hepatology, McGuire Veterans Affairs Medical Center, Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine
Douglas M Heuman, MD, FACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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