Large Bowel Obstruction, Ogilvie Syndrome, and Stercoral Colitis: When Is Dilatation Pathologic? How Are These Conditions Managed?
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.
KeywordsLarge bowel obstruction Ogilvie syndrome Stercoral colitis Neostigmine Pseudo-obstruction
- 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.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