Laboratory Studies

Laboratory studies are directed at establishing the etiology of the acute megacolon (acute colonic pseudoobstruction [ACPO], Ogilvie syndrome), assessing the patient’s fluid status, as well as evaluating the presence of any complications. These studies include the following:

Complete blood cell (CBC) count
Electrolyte levels (including calcium, magnesium, and phosphorus)
Serum lactate level
Blood urea nitrogen (BUN) and creatinine measurements
Levels of aminotransferases, alkaline phosphatase, bilirubin, amylase, and lipase (to evaluate for other potential causes of abdominal pain)
Thyroid studies
Stool studies (including leukocytes, ova and parasites, and C difficile toxin assay)
Blood cultures

Imaging Studies

Imaging studies are used to determine the severity of acute colonic pseudoobstruction (ACPO) (acute megacolon, Ogilvie syndrome), to exclude free intraperitoneal air (perforation) as well as other etiologies (eg, extrinsic compression), and to follow the clinical course.^[17]

Plain x-ray films of the abdomen demonstrate the massive gaseous distention of the colon. Generally, the small bowel is not seen. Dilation of all segments of the colon support the diagnosis of pseudoobstruction.

Other imaging studies, such as hypaque (water soluble radiopaque contrast material) enema, computed tomography (CT) scanning, or magnetic resonance imaging (MRI), may also be used to exclude obstruction.

Procedures

Perform other tests only to rule out a mechanical obstruction. Depending on the setting, severity, and condition of the patient, these tests may include either a colonoscopic examination (which also may be therapeutic) or a water-soluble contrast enema. Colonoscopy is preferred because of its diagnostic and therapeutic potential.

Treatment & Management

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Author

Roberto M Gamarra, MD Consulting Gastroenterologist, Digestive Health Associates, PLC

Roberto M Gamarra, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Coauthor(s)

Ali H Zakaria, MD Fellow, Department of Gastroenterology, Ascension Providence Hospital, Novi Campus, Ascension Health System

Ali H Zakaria, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Jordan Medical Association

Disclosure: Nothing to disclose.

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

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: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University 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, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

David Manuel, MD Affiliate Faculty, Department of Medicine, Loyola University Health System; Gastroenterologist, Digestive Health Center

David Manuel, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Crohn's and Colitis Foundation of America

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author, Clifford Y Ko, MD, MS, to the development and writing of this article.