Ogilvie Syndrome

Question 1

what is the defn of “Ogilvie Syndrome”?

Answer 1

acute gross dilation of caecum (>10cm) + R hemi-colon (occ => rectum) in the absence of an anatomic lesion that obstructs the flow of intestinal contents

Question 2

What underlying ds can Ogilvie Syndrome me associated w/?

Answer 2

trauma - #
infxn - pneumonia/sepsis
cardiac - MI/Hrt failure
O&G - c-section/normal vag delivery, spinal anaesthesia during childbirth
retroperitoneal pathology - malignancy/haemorrhage
surgery - pelvic, abd, orthos
neurological conditions
drugs - opiate, CCB, epidural analgesics, anti-cholinergic
others - metabolic, cancer, resp failure, renal failure

Question 3

What are the clinical features of Ogilvie Syndrome?

Answer 3

N&V, abd pain, constipation + paradoxically diarrhoea
abd distention
dx of exclusion

Question 4

When should you be worried about colonic perforation?

Answer 4

distention >12cm, been present for >6 days

Question 5

How does one manage Ogilvie Syndrome?

Answer 5

Conservative therapy continued for 24-48hrs if no excessive pain or no excessive caecal dilation
Supportive mgmt - serial PE + AXR every 12-24hrs)
+ Selective use of neostigmine + colonoscopy for decompression

Question 6

What does the Law of Laplace state?

Answer 6

in a long pliable tube, the site of largest diameter req the least pressure to distend - so, in a pt w/ distal large bowel obstruction, in setting og competent ileocaecal valve, the caecum = most common site of perforation