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Colonic pseudo-obstruction in surgical patients
American Journal of Surgery
|February 1, 1985
Summary
Ogilvie's syndrome, or colonic pseudo-obstruction, affects surgical patients and mimics true bowel obstruction. Early diagnosis and decompression, via endoscopy or surgery, improve outcomes, while delayed treatment risks severe complications and high mortality.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Colonic pseudo-obstruction, known as Ogilvie's syndrome, presents a diagnostic challenge in surgical patients.
- It is associated with various comorbidities including trauma, uremia, diabetes, cardiac failure, advanced cancer, and narcotic addiction.
Observation:
- Ogilvie's syndrome must be differentiated from mechanical bowel obstruction, cecal volvulus, and ischemic colitis.
- Progressive colonic distention, especially cecal dilatation exceeding 14 cm, increases the risk of gangrene, infarction, and perforation.
Findings:
- Colonoscopy offers a less invasive method for decompression but carries risks of failure, recurrence, and potential danger in massively distended colons.
- Surgical decompression options include cecostomy, exteriorization, or resection, particularly when infarction is present.
Implications:
- Early recognition and prompt decompression, whether endoscopic or surgical, are crucial for favorable patient prognosis.
- Delayed diagnosis and treatment, especially with resulting perforation or gangrene, lead to a nearly 50% mortality rate.