Acute Pseudo-Obstruction of the Colon (Ogilvie’s Syndrome) a Recurring Diagnostic Dilemma

Awe JAA (MBBS Ibadan; FWACS; FICS; DBLS; FRCS)

Consultant General Surgeon and Associate Professor of Surgery, Department of Surgery, College of Health Sciences, Igbinedion University, Okada; Edo State, Nigeria.

E-mail address: doset2007@yahoo.com 

Accepted 23 June, 2014

Abstract

Acute colonic pseudo-obstruction (Ogilvie’s Syndrome) is a rare clinical disease characterized by either total or segmental distension of the colon caused by paralysis without mechanical obstruction. The condition was first described in 1948 by Ogilvie when he postulated it as a condition caused by imbalance between the sympathetic and parasympathetic innervations of the colon. Up till now its etiology and patho-physiology still remains poorly understood. Though formerly associated primarily with the post operative state, this entity is increasingly being recognized in association with a wide variety of major medical problems. Clinically, the syndrome manifests itself as an acute abdominal distension, the caecum being the site of greatest dilatation, and the situation could be rapidly progressive and if left untreated it may cause caecal necrosis and perforation which could be fatal. Treatment remains largely empirical. The choice involves the time honored bowel rest of nasogastric tube decompression with supportive care; while a wide variety of pharmacologic approaches have been advocated. However, surgical intervention may be required if the required improvement is not achieved so as to avoid bowel perforation with its attendant mortality. The aim of this article is to draw the attention of clinicians to this rare disease; especially when colonic obstruction is suspected one should always consider the possibility of Ogilvie’s Syndrome as one of the differential diagnosis.

Keywords: Acute, Pseudo-Obstruction, Colon, Syndrome