Intestinal Pseudo-Obstruction Clinical Presentation

Updated: Jul 23, 2018
  • Author: Burt Cagir, MD, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Presentation

History

Intestinal pseudo-obstruction (also referred to as acute colonic pseudo-obstruction [ACPO] or Ogilvie syndrome) occurs most commonly in debilitated, hospitalized patients with multiple medical problems and is associated with various medical and surgical conditions. [14, 27, 28, 29, 30, 31, 32] Surgical patients begin developing symptoms, which are often insidious in onset, an average of 3-5 days postoperatively. [2, 16, 25] Whether this disorder is associated with either medical or surgical conditions, the presenting signs and symptoms are similar.

Presenting symptoms include the following:

  • Abdominal pain (80%)

  • Nausea and vomiting (80%)

  • Obstipation (40%); as many as 40% may have a recent history of flatus or passage of stool

  • Fever (37%)

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Physical Examination

Physical findings may include the following:

  • Abdominal distention (90-100%)

  • Abdominal tenderness (64%)

  • Hypoactive, high pitched, or absent bowel sounds (60%); normal or hyperactive bowel sounds (40%)

  • Empty rectum on digital examination

Vanek et al documented the presence of abdominal distention in virtually all patients with colonic pseudo-obstruction. [16] A subsequent report by Grassi et al found that the most relevant clinical finding in Ogilvie syndrome is abdominal distention, which arises suddenly, has a progressive course, and may worsen. [41]

Abdominal tenderness is noted in patients with perforated or ischemic bowel and in patients with viable bowel. As a rule, no significant differences are noted in the symptoms of patients with ischemic or perforated bowel compared with patients with viable bowel, except for a higher incidence of fever.

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