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At least 271 records · Page 15Linked to original sources
PubMed1986

Acute colonic pseudo-obstruction or Ogilvie's syndrome. Report of two cases treated with colonoscopic decompression and review of the literature.

Acute colonic pseudo-obstruction (ACP), or Ogilvie's syndrome, is a disorder characterized by massive dilatation of the colon, and typically occurs in the critically ill or post-operative patient. The clinical presentation may be impossible to distinguish from mechanical causes of colonic obstruction. Its importance is reflected in an overall mortality of up to 30%, perforation of the cecum occurring in 14.8% of patients with a reported mortality of up to 46%. Medical therapy has had variable results. Tube cecostomy or other operative interventions can lead to much morbidity and mortality in the critically ill patient. Colonoscopy recently has proven to be highly effective in achieving colonic decompression as well as excluding a mechanical etiology for obstruction and poses minimal risk to the patient. Colonoscopy should be reserved for patients who show progressive cecal dilatation or who deteriorate clinically despite aggressive medical therapy. We report two patients with ACP treated with colonoscopy and review the literature.

Acute Disease↗
PubMed1985

[Acute pseudo-obstruction of the colon (Ogilvie's syndrome). Internal medicine aspects].

Four patients with acute colonic pseudo-obstruction are described. The clinical and radiological picture is suggestive of colonic obstruction, without detectable organic obstruction. The syndrome usually occurs after surgery or trauma, or is related to severe preexisting systemic illness; its association with alcohol intake is frequently overlooked. The most severe complication is cecal rupture, which may occur at a diameter of 12 cm or more and which has a lethality rate of 40%. The primary management of colonic pseudo-obstruction is conservative, and includes an attempt at colonoscopic decompression; in most cases cecostomy can be avoided.

Adult↗
PubMed1985

[Acute pseudo-obstruction of the colon--significance of colonoscopy for diagnosis and therapy].

Acute colonic pseudoobstruction (Ogilvie's syndrome) predominantly involves elderly patients with serious underlying diseases and is defined by massive colonic distention without mechanical obstruction. Therapy of choice included surgical cecostomy with a mortality rate of over 30 percent. Fiberoptic coloscopy provides a new effective treatment modality for colonic decompression. We discuss the cases of 8 patients with Ogilvie's syndrome, who were successfully treated by colonoscopic decompression. Special guidelines for successful and safe performance of the procedure are suggested.

Acute Disease↗
PubMed1985

[Acute pseudoobstruction of the colon (Ogilvie syndrome)].

Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute distension of the large bowel without distal obstruction. Apart from few idiopathic cases, the syndrome usually is associated with postoperative, posttraumatic or metabolic disorders of extraintestinal origin. Without treatment, increasing distension leads to cecal perforation with a high mortality. Treatment is conservative initially. If decompression by colonoscopy fails, cecostomy or right hemicolectomy are mandatory. The pathophysiologic mechanism of acute colonic pseudoobstruction is unknown. Whether Ogilvie's syndrome is a genuine clinical entity or a complication of associated diseases is still on question.

Acute Disease↗
PubMed1979

[Colonic diverticulitis and appendicitis].

A retrospective analysis of the clinical data has shown that a complicated diverticulitis can often simulate the clinical picture of acute appendicitis. The methods of diagnosis and surgery of the complicated diverticulum are recommended in which the operations in many steps (extraperitonization, colostomy, cecostomy, resection) are considered to be preferable.

Acute Disease↗
PubMed1983

[Pseudo-obstruction of the colon].

Pseudoobstruction of the colon is characterized by clinical and radiological findings suggesting a mechanical obstruction of the large intestine without any organic cause. 11 of our patients and 344 cases reported in the literature have been reviewed. 90% of the patients have an associated major system disorder, most of them (40%) are localized in the pelvis. An imbalance in sympathetic-parasympathetic innervation as an aetiological factor is discussed. Diagnosis is generally made on the basis of the plain roentgenogram of the abdomen and a barium enema of the colon. Surgical decompression is indicated when no improvement can be achieved by conservative treatment within 72 hours. Immediate surgical intervention becomes mandatory in case of the cecal diameter being greater than 12 cm or an evident perforation. Cecostomy is of crucial benefit. Extensive necrosis requires a colonic resection.

Adult↗
PubMed1984

Non-obstructive colonic dilation: radiologic findings in 50 patients following colonoscopic treatment.

Fifty patients with acute onset of colonic dilatation without mechanical obstruction were evaluated before and after colonoscopic decompression. Colonic dilatation, as demonstrated radiographically, was segmental or consistent with mechanical obstruction in 33 (66%). Signs of impending cecal perforation were seen in five (10%) and these patients had colonoscopic decompression, tube cecostomy, or both. Following colonic decompression, cecal diameter may remain unchanged for two to four days, despite decreased abdominal girth and even shortening of the colon radiographically. Improvement in pain, distention, tenderness, fever and leukocytosis may precede radiographic improvement. The radiologist must recognize this entity, look for signs of impending perforation and signs of bowel shortening, with or without decompression after treatment. Barium studies of the colon should be avoided since they can hamper the endoscopic diagnosis and treatment of colonic dilatation.

Adult↗
PubMed1983

A technique for rapid intubation of the sigmoid and left colon.

Repeated endoscopic intubation of the left colon resulted in decompression of the cecum in all four patients with pseudo-obstruction of the colon complicating critical illnesses. The technique involved fiberoptic sigmoidoscopy and placement of a large-bore tube above the sigmoid flexures under visual control. The technique is rapid, safe and readily repeatable and deserves a trial prior to undertaking cecostomy.

Colon↗
PubMed1982

Pfannenstiel wound dehiscence complicated by cecal bascule.

A 43-year-old female with a Pfannenstiel wound dehiscence complicated by cecal bascule is reported. The etiology of both cecal bascule and dehiscence is discussed. Contributing factors in this case include increased intra-abdominal pressure from the cecal bascule, and a running catgut closure of the anterior rectus sheath. When the diagnosis of cecal bascule is made, cecostomy with cecopexy is the treatment of choice. For prevention of wound disruption, the optimal closure of a Pfannenstiel incision utilizes interrupted nonabsorbable suture material.

Adenocarcinoma↗
PubMed1983

Pneumatosis coli: a case presentation and review of the literature.

The case of pneumatosis coli presented here was felt to have occurred concomitantly with chronic obstructive pulmonary disease in combination with prolonged intestinal distention. This condition usually requires no treatment because it is often self-limiting. In this case, because of radiographic and clinical findings suggestive of intestinal obstruction, the patient underwent an exploratory laparotomy and tube cecostomy for decompression and drainage of the markedly distended cecum and transverse colon.

Adult↗
PubMed1994

[A rare cause of intestinal pseudo-obstruction: Ogilvie's syndrome].

The authors report four cases of Ogilvie's syndrome, a rare cause of intestinal pseudo-obstruction. After having reviewed the pathogenetic hypotheses reported in the international literature, the authors describe the symptoms, diagnostic iter and conservative and surgical management. With regard to the latter, the authors report their own experience which differs from that reported in the literature since they advocate the use of intraoperative colonoscopy for both decompressive and diagnostic purposes, the use of the cecal fistula instead of mid-canal cecostomy, and the application of a multi-fenestrated endocolic probe inserted through the anus and as far as the left colic angle for further decompressive purposes.

Aged↗
PubMed1993

[Surgical indications in acute pseudo-obstruction of the colon (Ogilvie syndrome)].

Acute pseudo-obstruction of the colon (APC), popularly known as Ogilvie's syndrome, has been the subject of numerous medical communications in the past two decades. In this paper three patients with APC managed surgically are presented. In two patients cecal perforation developed; in the third patient a discharge cecostomy was carried out because of a caecal diameter of 16 cm. Indications for the operative management of these patients include pneumoperitoneum, development of peritonitis in the area of the cecum, continued cecal distention after 48-72 hours of therapy with or without colonoscopy, cecal diameter greater than 12 cm, respiratory failure and uncertain diagnosis.

Acute Disease↗
PubMed1993

[Prolonged decompression of the small intestine in the surgical treatment of acute intestinal obstruction and peritonitis].

Prolonged decompression of the small intestine was used in the complex surgical treatment of 85 patients with acute ileus (67) and peritonitis (18). The main stage of the operation included liquidation of ileus and elimination of a source of peritonitis. Antegrade nasogastric intubation of the intestine was performed in 54 patients, via gastrostomy--in 3, retrograde intubation via cecostomy--in 15, via appendicostomy--in 4, via ileostomy--in 9. Performance of active transtubal sanation of the intestine by means of antiseptic solutions (53 cases) in combination with enterosorption (17) contributed to essential increase in the effectiveness of treatment.

Acute Disease↗
PubMed1996

Intestinal pseudo-obstruction (Ogilvie's syndrome) in theophylline overdose.

Intestinal pseudo-obstruction (Ogilvie's syndrome) has previously been reported in 2 patients with theophylline toxicity treated with activated charcoal (AC), mechanical ventilation and opioid induced sedation. We report a case of Ogilvie's syndrome in a theophylline toxic patient treated with AC. A 45-y-old male with severe chronic obstructive pulmonary disease presented with vomiting and multifocal atrial tachycardia after an intentional theophylline overdose. His initial potassium concentration was 2.7 mEq/L and his theophylline was 191 mg/L (1060 mumol/L). The patient was hemodialyzed and given a total of 1,000 g of AC without cathartics during the first hospital day. He also received iv potassium replacement. On the second hospital day he required mechanical ventilation for respiratory acidosis. Clindamycin was given for purulent sputum and fever. Haloperidol was given to treat agitation. No other anticholinergic agents or opioids were given. The patient's potassium rose to 6.5 mEq/L and he was given kayexalate. During the third hospital day the patient developed abdominal distention, tenderness and leukocytosis. Abdominal radiographs revealed a distended cecum. In the operating room the cecum was found dilated to 16 cm with no distal obstruction. A cecostomy tube drained AC and pill fragments. A 6 cm charcoal bezoar was found in the stomach. The patient recovered uneventfully.

Administration, Oral↗
PubMed1996

Antegrade colonic enema (ACE): a new therapeutic approach to chronic constipation.

Continent appendio-cecostomy is a recently developed operation for the therapy of chronic constipation, refractory for other treatment modalities. Two patients are described in whom the operation led to a dramatic improvement of their quality of life. Technical details of the operation are offered as well as some data on the possible mechanism of colonic motility in this pathological disorder.

Adult↗
PubMed1997

[An unusual cause of intestinal obstruction in the puerperal period (case report)].

The authors present a case report of acute intestinal obstruction which manifested itself on the fourth day after the delivery of twins by Caesarian section. Compression of the rectosigmoid colon by the enlarged uterus--which was as big as a pregnant uterus in its fourth month--was established as the cause of ileus. Acute intestinal obstruction was obviously caused by sudden enormous enlargement of the antero-posterior dimension of the contracting uterus at the aditus pelvis level. The situation was successfully surgically resolved by the employment of temporary tube cecostomy.

Acute Disease↗
PubMed1997

[Diagnostic problems, pathogenetic hypothesis and therapeutic proposals in Ogilvie's syndrome. Review of 470 observations from the literature and presentation of 5 new cases].

The authors describe five cases of acute pseudo-obstruction of the colon: the first, alcoholic, treated with antidepressant drugs, with a long history of intestinal occlusions and explorative laparotomies, treated successfully by conservative therapy; the second, with meningitis, in which right colectomy for the presence of multiple perforations of the cecum was performed; the third with acute neurological problems of ischemic nature, died before any treatment was given; the fourth, with left hemicolectomy performed for cancer, in which transversostomy was performed after colonoscopy and medical treatment with prokynetic drugs had failed; the last one, in a young woman treated with anti-depressant and antipsychotic drugs, treated by conservative therapy. In reviewing 470 cases from the literature the most commonly associated disorders are found; 33 patients (7%) were diagnosed as idiopathic. Only 273 cases were available for detailed analysis of age, sex, mode of treatment, presence of perforation, mortality rate. The mortality rate was 17.6%. When comparing the different treatment procedures, surgery has a higher mortality rate (23.5%) than medical treatment or colonoscopy (12.1%) (p < 0.02). In this study the presence of perforation increased mortality from 15.1% to 29.9% (p < 0.03). The mortality rate for cecostomy is 15.3% vs 30.1% for other surgical procedures. Recently the syndrome pathogenesis is attributed to an autonomic imbalance, between the sympathetic and parasympathetic innervation of the colon: sympathetic prevalence due to sacral parasympathetic derangement, lead to inhibition of colonic peristalsis. The attention must be focused on early diagnosis and prompt treatment; for this purpose colonoscopy seams to be a safe method of establishing the diagnosis and carrying out treatment.

Adult↗