Definition

What is Ogilvie syndrome?

Ogilvie syndrome is an acquired disorder characterized by abnormalities affecting the involuntary, rhythmic muscular contractions (peristalsis) within the colon. Peristalsis propels food and other material through the digestive system through the coordination of muscles, nerves and hormones. The colon is often significantly widened (dilated).

How common is Ogilvie syndrome?

Ogilvie syndrome is rare. It is believed to affect males and females in equal numbers, although one large study suggested that males may be affected more often than females. Ogilvie syndrome can potentially affect individuals of any age, but most often occurs in late middle age (mean age in the 60s). Please discuss with your doctor for further information.

Symptoms

What are the symptoms of Ogilvie syndrome?

The common symptoms of Ogilvie syndrome are:

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes Ogilvie syndrome?

The exact cause and underlying mechanisms of Ogilvie syndrome are not fully understood and controversial. The disorder most often occurs in individuals with a recent, serious medical condition or surgical procedure.

The list of conditions that have been associated with Ogilvie syndrome is extensive. The three most common conditions associated with Ogilvie syndrome are non-operative trauma, infection and heart disease, especially a heart attack (myocardial infarction) or congestive heart failure. The most common infections associated with Ogilvie syndrome are pneumonia and sepsis. Surgeries that have been associated with Ogilvie syndrome include abdominal, orthopedic (especially total hip replacement), neurologic, urologic and cardiac surgery. Severe pulmonary disease, malignancy, kidney (renal) disease, respiratory failure, metabolic disorders and severe electrolyte imbalances have also been associated with Ogilvie syndrome.

The use of certain medications has also been associated with the development of Ogilvie syndrome including neuroleptic medications, anticholinergics, amphetamines, steroids and narcotics.

Ogilvie syndrome most likely results from abnormalities affecting the autonomic nervous system’s control of colonic motor function. The autonomic nervous system is the portion of the nervous system that controls or regulates certain involuntary body functions including heart rate, blood pressure, temperature regulation, breathing and more. The autonomic nervous system also controls or regulates the bowels and bladder.

Risk factors

What increases my risk for Ogilvie syndrome?

There are many risk factors for Ogilvie syndrome, such as:

  • Recent obstetric, gynaecological or pelvic surgery.
  • Recent trauma or orthopaedic procedure.
  • Underlying infection.
  • Recent cardiac events.
  • Electrolyte imbalance.
  • Medications (eg, opioids, antidepressants).
  • Solid organ transplant.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Ogilvie syndrome diagnosed?

A diagnosis of Ogilvie syndrome is made based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and a variety of specialized tests to rule out other conditions or identify underlying causes.

Ogilvie syndrome is virtually indistinguishable from mechanical obstruction based solely on signs and symptoms. X-ray examination of the colon will be performed to rule out mechanical obstruction. Plain abdominal films (radiographs) can reveal an abnormally expanded (dilated) colon. Plain abdominal radiographs can also reveal dilation and abnormal air-fluid levels in the small bowel, both of which are indicative of intestinal obstruction.

A water-soluble enema or computed tomography should be performed to rule out mechanical obstruction in cases where gas and distention does not occur throughout the entire colon. A water-soluble enema is a procedure that allows a physician to evaluate the large bowel. During the exam, a soft, thin tube is inserted into the anal passage. Dye is injected into the tube and x-rays will be taken. The dye will show the outline of the large bowel on the x-ray, revealing mechanical obstruction if present. During CT scanning, a computer and x-rays are used to create a film showing cross-sectional images of certain tissue structures such as the colon.

How is Ogilvie syndrome treated?

There is no specific therapy for Ogilvie syndrome. Therapeutic options include support therapy, medications, decompression and surgery. Most therapeutic options have not undergone extensive controlled clinical study.

Specific therapeutic procedures and interventions may vary, depending upon numerous factors, such as disease progression; the presence or absence of certain symptoms; the status of the bowel; an individual’s age and general health; and/or other elements. Decisions concerning the use of particular therapeutic options should be made by physicians and other members of the health care team in careful consultation with the patient based upon the specifics of his or her case; a thorough discussion of the potential benefits and risks, including possible side effects and long-term effects; patient preference; and other appropriate factors.

When planning treating, physicians must weigh conservative treatment and observation versus proceeding with a surgical decompression of the dilated colon. Most individuals respond to conservative management.

The initial management of Ogilvie syndrome requires an examination to detect signs of bowel perforation or ischemia. Signs of these complications require immediate medical intervention.

In cases where an identifiable cause for Ogilvie syndrome (e.g., respiratory failure, congestive heart failure, infection) has been established, treatment of the underlying condition is mandatory. If Ogilvie syndrome is linked to the use of certain medications, affected individuals must stop taking the medications.

Supportive therapy may include withholding oral food and fluid intake, administering intravenous fluids to correct fluid and electrolyte imbalances, employing nasogastric suction to limit the amount of air that is swallowed to avoid air from further expanding the colon, and inserting a long, thin tube into the rectum to allow the release of gas and stool, a procedure known as rectal tube to gravity drainage. Stopping the use of medications that can affect colon motility such as opiates and anticholinergics is also recommended. The success of supportive therapy varies among affected individuals.

One of the few treatment options for Ogilvie syndrome that has undergone clinical study is a medication known as neostigmine. Studies have shown that intravenous administration of neostigmine has led to rapid decompression of the colon in individuals with Ogilvie syndrome who did not respond to conservative management. Neostigmine is believed to interfere with the breakdown of the neurotransmitter acetylcholine, increasing the duration and activity of acetylcholine. Acetylcholine helps the communication between nerve and muscle cells, such as those in the GI tract. Neostigmine improves GI motility and increases the transit of food and other material through the GI tract. Although infrequent, colonic distention can recur following successful treatment with neostigmine.

Some individuals with Ogilvie syndrome may be treated with colonic decompression, a procedure that reduces pressure within the colon. Usually, this treatment is reserved for individuals with persistent, marked colonic distention who have not responded to other treatment options. A specific procedure known as colonoscopic decompression, in which a thin, flexible tube is inserted into the anal passage and threaded up to the colon, may be used. Although colonoscopic decompression has not undergone clinical study, numerous reports in the medical literature cite it as an effective method for removing air from the colon and, potentially, reducing the risk of perforation. In addition, some individuals may require the insertion of a decompression tube within the colon in to order to achieve decompression or reduce the risk of recurrence. Decompression techniques carry risks including perforation. There is also a risk of disease recurrence.

In rare cases, individuals with Ogilvie syndrome may require surgical intervention. Surgery is used when affected individuals have signs of perforation or ischemia or have failed to respond to other treatment options. Surgery can be associated with significant morbidity and mortality due in part to the severity of the underlying condition. The specific type of surgery used may vary depending upon the status of the bowel. If perforation or ischemia is not present, a cecostomy is usually performed. A cecostomy is a procedure in which an artificial opening is created in the cecum, allowing physicians to “vent” excess air or contents from the colon. This procedure has a high success rate in individuals with Ogilvie syndrome.

If perforation or ischemia is present, surgery to remove a portion of the colon (subtotal colectomy) may be necessary. The specific surgical procedure used can vary based upon several factors such as the status of the cecum.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Ogilvie syndrome?

The following lifestyles and home remedies might help you cope with Ogilvie syndrome:

  • Stay active and exercise if possible.
  • Drink plenty of fluid.
  • Avoid staying in bed for long periods of time.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: May 22, 2018 | Last Modified: May 22, 2018

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