Ogilvie Syndrome Workup

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

Laboratory Studies

  • CBC count: Leukocytosis should raise concerns for possible impending or frank perforation.
  • Electrolytes: Disorders of potassium, sodium, calcium, and magnesium may be the underlying cause of the problem. Patients with colonic pseudo-obstruction are commonly dehydrated and frequently exhibit prerenal azotemia or renal insufficiency.
  • Liver function profile
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Imaging Studies

Plain abdominal films

This is the most useful diagnostic tool for this disorder. Plain and upright abdominal films show a dilated colon, often from the cecum to the splenic flexure and occasionally to the rectum. Haustral markings remain normal. Serial films may be used to follow the clinical course and the response to treatment.

Specific attention to the diameter of the colon is important. If the colonic diameter exceeds 10 cm, decompression of the colon must be considered and expedited. In addition to cecal diameter, the duration of distension also appears to be an important factor in perforation risk, with the risk lowest in patients who undergo decompression within less than 4 days of onset.

CT scan

While a CT scan is not required to establish a diagnosis, it may be helpful in excluding the presence of frank perforation, obstruction, and toxic megacolon.[4]

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Other Tests

Gastrografin enema

Gastrografin is water-soluble and has a high osmolarity; therefore, this contrast medium tends to cause a fluid shift into the colon and may subsequently increase colonic motility. A Gastrografin enema may be both diagnostic and therapeutic for this disorder.

Barium enema

Given the nature of pseudo-obstruction, air should not be instilled into the colon if this procedure is performed.

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Procedures

Colonoscopy

This examination may be helpful diagnostically and therapeutically.

This single procedure can help exclude an obstructive process and decompress the colon.

This may be technically difficult because of the difficulty in adequately preparing the colon in order to allow good endoscopic visualization.

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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.

References

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