[Acute colonic pseudo-obstruction: Ogilvie syndrome]

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Acute colonic pseudo-obstruction (ACPO) presents as significant colonic dilation without mechanical obstruction.
• It is associated with severe underlying illnesses or postoperative states, carrying a substantial mortality rate (25-30%, up to 50% with complications).
• Pathogenesis remains unclear, and symptoms are nonspecific, necessitating differentiation from colonic obstruction and toxic megacolon.

Purpose of the Study:

• To outline the diagnostic criteria and management strategies for acute colonic pseudo-obstruction.
• To emphasize the importance of differentiating ACPO from other conditions causing colonic dilation.
• To review therapeutic options ranging from conservative measures to surgical interventions.

Main Methods:

• Diagnosis relies on clinical evaluation, blood tests, and radiological imaging (plain abdominal radiograph, CT, water-soluble contrast enema).
• Initial management involves supportive therapy, including gastrointestinal decompression and addressing predisposing factors.
• Treatment escalation includes neostigmine administration, endoscopic decompression, and, in refractory or complicated cases, surgical options like cecostomy or colonic resection.

Main Results:

• Supportive therapy resolves ACPO in uncomplicated cases, requiring close clinical and radiological monitoring.
• Neostigmine demonstrates durable success in approximately 75% of patients unresponsive to initial treatment.
• Endoscopic decompression is effective for neostigmine-refractory cases, while surgery is reserved for persistent non-responders or those with complications like ischemia or perforation.

Conclusions:

• ACPO is a serious condition requiring prompt diagnosis and management to mitigate mortality risks.
• A stepwise therapeutic approach, starting with conservative measures and progressing to pharmacologic, endoscopic, or surgical interventions, is essential.
• Accurate differentiation from other causes of colonic dilation and vigilant monitoring for complications are critical for successful patient outcomes.