[Colonic pseudo-occlusion syndrome. Ogilvie's syndrome Apropos of 22 cases]

The syndrome of pseudo colonic obstruction consists of acute or subacute colonic dilatation which presents the diagnostic and therapeutic problems of any low bowel obstruction. Our experience is based on a series of 22 cases and is similar to data in the literature. There is a specific aetiological context: elderly subjects, vascular and neurological diseases, severe infection, trauma, alcoholism. The exclusion of an organic occlusion is not always an easy diagnosis and may require an exploratory laparotomy. The clinical course is dominated by the risk of diastatic perforation which carries a heavy mortality. In the majority of cases, the colonic peristalsis is restored by early diagnosis, repeated decompression with a rectal catheter, together with general measures of rehydration, control of infection and maintenance of satisfactory haemodynamic conditions. In the other cases, a draining colostomy may be required. The pathophysiological mechanism of this form of colonic ileus remains hypothetical, in which various neurogenic, vascular, toxic or metabolic factors may be involved.