Acute colonic pseudo-obstruction: a possible role for the colocolonic reflex

In diverse clinical settings, injury or impairment of the peripheral autonomic nervous system may cause acute colonic pseudo-obstruction. The mechanism has remained elusive since Ogilvie's original description. In classic Ogilvie's syndrome, colonic pseudo-obstruction is associated with malignant invasion of the prevertebral ganglia, and may be mediated through the colocolonic reflex, described in a guinea pig model. We have treated three patients with acute colonic pseudo-obstruction due to: 1) malignant invasion of the prevertebral plexus (classic or true Ogilvie's syndrome), 2) clonidine, and 3) herniorrhaphy under epidural anesthesia. In this paper, we discuss the possible role of the colocolonic reflex in the pathophysiology of acute colonic pseudo-obstruction, and the delineation of true Ogilvie's syndrome from the other many causes of acute colonic pseudo-obstruction.