[Ogilvie syndrome]

Ogilvie's syndrome is a rare condition with progressive dilatation of the proximal colon without mechanical obstruction. Untreated it can lead to coecal perforation, peritonitis and death. It develops in patients with medical or surgical complications, but can be idiopathic. Caesarean section is the most common preceding surgical procedure. An imbalance between the parasympathetic and the sympathetic innervation of the intestine is thought to be the cause. Trauma to the retroperitoneum, infections, bleeding and electrolyte disturbances, hormonal changes and medicamina are predisposing factors. The syndrome can result in perforation of the coecum as early as the third or fourth day. Therefore a diagnostic abdominal X-ray should not be delayed by the intermittent presence of flatus and stool which is characteristic for this pseudo-obstructive condition. Medical treatment with neostigmine may be successful, coloscopic decompression of the colon is effective as is placing a tube in or close to coecum. If laparotomy is necessary, coecostomy has lower mortality than ileo-coecal resection.