Advertisement

Large Bowel Obstruction, Ogilvie Syndrome, and Stercoral Colitis: When Is Dilatation Pathologic? How Are These Conditions Managed?

  • Scott H. PasichowEmail author
  • Angela F. Jarman
Chapter

Abstract

Large bowel obstruction is a mechanical blockage of the colon causing abdominal distention and decreased bowel function. It is defined as 6 cm of colonic dilation or 9 cm of cecal dilation. Ogilvie syndrome, or colonic pseudo-obstruction, is a large bowel obstruction without an anatomic lesion, while stercoral colitis is dilation from impacted stool causing bowel wall inflammation. Although mechanical obstructions and volvulus generally require surgical management, pseudo-obstruction without 12 cm or more of dilation, peritonitis, or severe pain can often be managed conservatively with aggressive bowel regimens. Neostigmine, a cholinesterase inhibitor, is shown to be up to 90% effective in Ogilvie syndrome cases when conservative therapies fail. When pharmacotherapies are unsuccessful, colonoscopic decompression or surgery may be needed.

Keywords

Large bowel obstruction Ogilvie syndrome Stercoral colitis Neostigmine Pseudo-obstruction 

References

  1. 1.
    Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986;29(3):203–10.CrossRefGoogle Scholar
  2. 2.
    Ballantyne GH. Review of sigmoid volvulus. Clinical patterns and pathogenesis. Dis Colon Rectum. 1982;25(8):823–30.CrossRefGoogle Scholar
  3. 3.
    Shera IA, Vyas A, Bhat MS, Yousuf Q. Unusual case of Hashimoto’s encephalopathy and pseudo-obstruction in a patient with undiagnosed hypothyroidism: a case report. J Med Case Rep. 2014;8:296.CrossRefGoogle Scholar
  4. 4.
    Weinstock LB, Chang AC. Methylnaltrexone for treatment of acute colonic pseudo-obstruction. J Clin Gastroenterol. 2011;45(10):883.CrossRefGoogle Scholar
  5. 5.
    Ünal E, Onur MR, Balcı S, Görmez A, Akpinar E, Boge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017 Jan;23(1):5–9.CrossRefGoogle Scholar
  6. 6.
    Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics. Radiology. 2015;275(3):651–63.CrossRefGoogle Scholar
  7. 7.
    Khurana B, Ledbetter S, McTavish J, Wiesner W, Rose PR. Bowel obstruction revealed by multidetector CT. Am J Roentgenol. 2002;178:1139–44.CrossRefGoogle Scholar
  8. 8.
    Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22(10):917.CrossRefGoogle Scholar
  9. 9.
    Korsten MA, Rosman AS, Ng A, Cavusoglu E, Spungen AM, Radulovic M, Wecht J, Bauman WA. Infusion of neostigmine-glycopyrrolate for bowel evacuation in persons with spinal cord injury. Am J Gastroenterol. 2005;100(7):1560.CrossRefGoogle Scholar
  10. 10.
    Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med. 1999;341(3):137.CrossRefGoogle Scholar
  11. 11.
    Sgouros SN, Vlachogiannakos J, Vassiliadis K, Bergele C, Stefanidis G, Nastos H, Avgerinos A, Mantides A. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut. 2006;55(5):638.CrossRefGoogle Scholar
  12. 12.
    Acute CM. Colonic pseudo-obstruction (Ogilvie’s syndrome) [internet]. 2017 [updated 2017 July 5; cited 2017 Aug 31]. Available from: https://www.uptodate.com/contents/acute-colonic-pseudo-obstruction-ogilvies-syndrome

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineAlpert School of Medicine of Brown UniversityProvidenceUSA

Personalised recommendations