Acute colonic pseudo-obstruction after caesarean section: a review and recommended management algorithm TOG 2019

Question 1

What is ogilivie syndrome

Answer 1

Sign/Sx large bowel obstruction without obvious mechanical obstruction

Question 2

Table showing symptoms, signs, Ix and DD in ACPO

Answer 2

Question 3

How to differentiate ACPO and obstruction

Answer 3

With ACPO - minimal NG aspirates, some bowel movement/BS, mild pyrexia, raised SIP

Ileus - No bowel sounds/flatus

Question 4

Most useful initial investigations for ACPO?

Answer 4

Abdo & chest XR

Caecal and large bowel dilatation

Consider CT

Question 5

Conservative management options?

Answer 5

Observation
NBM
NG tube
Withdraw opiates
Rehydration
Correct electrolytes
VTE proxysis

Question 6

If conservative measures do not work after 48-72 hours or caecal diameter static/increasing?

Answer 6

Consider medical treatment with neostigmine

or

Endoscopic treatment if >9-12 cm
Colonoscopy +/- placement of soft renal decompression tube

Question 7

When is surgical management recommended?

Answer 7

If suspicion of perforation/bowel ischaemia

Perforation risk > with caecal dilatation

Question 8

Treatment algorithm for Acute colonic pseudo-obstruction?

Answer 8