Ogilvie Syndrome Treatment & Management

  • Author: Prospere Remy, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 5, 2012
 

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%.

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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.

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Consultations

  • Gastroenterologists
  • General surgeons
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Diet

In general, patients with Ogilvie syndrome are not allowed to have anything by mouth until the disorder is reversed.

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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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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)

Kavitha Kumbum, MD  Associate Program Director and Attending Physician, Gastroenterology Fellowship Program, Division of Gastroenterology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine

Kavitha Kumbum, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Steven Lee Carpenter, MD, FACP, AGAF, FASGE  Academic Chair, Associate Professor of Medicine, Department of Internal Medicine, Internal Medicine Program Director, Mercer University School of Medicine; Senior Partner, The Center for Digestive and Liver Health, The Endoscopy Center

Steven Lee Carpenter, MD, FACP, AGAF, FASGE 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.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF 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: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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