Ogilvie Syndrome Treatment & Management
- Author: Prospere Remy, MD; Chief Editor: Julian Katz, MD more...
Medical Care
Diagnosis and management of colonic pseudo-obstruction require that mechanical bowel obstruction be completely excluded.[5] Initial management requires an evaluation for signs of bowel ischemia or perforation; if present, these problems must be addressed immediately.
Addressing basic issues of supportive care prior to initiating specific medical therapy is critical. Aggressively treat any reversible underlying medical condition (eg, respiratory failure, congestive heart failure [CHF], systemic infection). Administer intravenous fluids to correct any volume deficit. Correct electrolyte imbalances.
Nasogastric suction or decompression can be helpful; furthermore, rectal tube decompression can be therapeutic in some cases.
Promptly discontinue any medications that might precipitate or exacerbate this problem (eg, narcotics, anticholinergics).
Colonoscopic decompression is a very useful method to remove air from the colon and, hopefully, to reduce the risk of subsequent colonic perforation; however, this procedure may be difficult to perform because of poor colonic preparation in most patients. Colonoscopy is successful in reducing colonic air in 70-85% of patients.
Decompression may be facilitated by placement of a decompression tube.
Passage of the endoscope to the hepatic flexure is usually sufficient to decompress the cecum.
If a decompression tube is placed, flush the tube every 2-4 hours with enough saline to maintain patency.
The main risk of decompressive colonoscopy is perforation. Maintain great care to avoid excessive air insufflation during endoscope insertion.
The risk of perforation is probably higher in patients with significant colonic ischemia.
Although colonoscopic decompression is usually successful, cecal distention often recurs. The literature indicates recurrence rates of 22-41%.
Surgical Care
A small percentage of patients with Ogilvie syndrome may require surgical intervention.
Tube cecostomy
This procedure allows for colonic venting in patients with Ogilvie syndrome. In some patients, this procedure is curative, and the tube may later be removed without the need for subsequent surgical intervention.
Reserve cecostomy for patients with impending cecal perforation.
Generally, a cecostomy is performed via open technique.
Percutaneous cecostomy may also be performed via CT guidance.
A laparoscopically assisted cecostomy using T-bars to anchor the cecum to the anterior abdominal wall is another acceptable intervention.
Subtotal colectomy
In patients with subsequent perforation, a subtotal colectomy may be required.
Generally, patients with perforation require temporary diversion, with plans for a second operation to establish bowel continuity at a later date.
Potential complications include abscess formation, ileus, and bleeding.
Consultations
- Gastroenterologists
- General surgeons
Diet
In general, patients with Ogilvie syndrome are not allowed to have anything by mouth until the disorder is reversed.
Activity
If the patient is able, ambulation can have beneficial aspects on colonic motility patterns. However, patients with acute Ogilvie syndrome typically are not ambulatory.
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