eMedicine Specialties > Gastroenterology > Intestine

Intestinal Pseudo-obstruction, Surgical Treatment: Follow-up

Author: Burt Cagir, MD, FACS, Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic
Coauthor(s): Lena M Napolitano, MD, FACS, FCCP, FCCM, Professor of Surgery, University of Michigan School of Medicine; Chief, Surgical Critical Care, Program Director, Surgical Critical Care Fellowship, Associate Chair, Department of Surgery, University of Michigan Health System; James Dunne, MD, Clinical Instructor, Department of Surgery, Trauma/Critical Care, University of Maryland Medical Center
Contributor Information and Disclosures

Updated: May 1, 2008

Outcome and Prognosis

Colonic distension can recur and may require multiple administrations of neostigmine. A single dose of neostigmine is effective for 1-2 hours. Neostigmine is effective in treating 85-90% of cases of Ogilvie syndrome. Recurrent or persistent colonic distension may cause ischemia and perforation.72  

Surgery for the treatment of colonic pseudo-obstruction has a 30% mortality rate, whereas conservative management has a 14% rate. If cecal perforation occurs, the rate can be up to 50%.13,27,16,2

A cecal diameter of greater than 14 cm, a delay in colonic decompression, and advanced age are predictors of colonic perforation.

Future and Controversies

All attempts should focus on prevention of acute colonic pseudo-obstruction in the hospitalized and postsurgical patient. Earlier mobilization and positioning of hospitalized patients has become an important preventive strategy in this regard. Furthermore, prevention of colonic distention by the more aggressive use of bowel regimens for the prevention of obstipation is critically important in hospitalized patients, who are particularly susceptible to this clinical condition.

The development of new and effective pharmacological agents for the treatment of acute colonic pseudo-obstruction would allow a substantial decrease in the need for surgical intervention, which is associated with considerable morbidity and mortality, and the authors hope that these agents will become available in the future.

 


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Follow-up: Intestinal Pseudo-obstruction, Surgical Treatment
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References
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Further Reading

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Keywords

intestinal pseudoobstruction, colonic pseudo-obstruction, Ogilvie's syndrome, Ogilvie syndrome, large intestinal obstruction, large bowel obstruction, cecal perforation, abdominal distention, abdominal sepsis, anastomotic dehiscence, intestinal fistula, abdominal compartment syndrome

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Contributor Information and Disclosures

Author

Burt Cagir, MD, FACS, Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic
Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Coauthor(s)

Lena M Napolitano, MD, FACS, FCCP, FCCM, Professor of Surgery, University of Michigan School of Medicine; Chief, Surgical Critical Care, Program Director, Surgical Critical Care Fellowship, Associate Chair, Department of Surgery, University of Michigan Health System
Lena M Napolitano, MD, FACS, FCCP, FCCM is a member of the following medical societies: Alpha Omega Alpha, American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Critical Care Medicine, American College of Physicians, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, Association for Academic Surgery, Association of VA Surgeons, Association of Women Surgeons, California Professional Society on the Abuse of Children, Eastern Association for the Surgery of Trauma, Phi Beta Kappa, Shock Society, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

James Dunne, MD, Clinical Instructor, Department of Surgery, Trauma/Critical Care, University of Maryland Medical Center
James Dunne, MD is a member of the following medical societies: Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Pharmacy Editor

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

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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