Ogilvie's syndrome (acute colonic pseudo-obstruction): review of the literature and report of 6 additional cases

Purpose. Ogilvie's syndrome is defined as an acute pseudo-obstruction of the colon, characterized by the signs, symptoms and radiological pattern of a large-bowel obstruction, but without a detectable organic cause. The actiology of Ogilvie's syndrome appears, to he multifactorial, with a series of possibly interacting pathogenic noxae all resulting in colon inactivity. Our study reports on six cases of Ogilvie's syndrome diagnosed and treated between 1997 and 2002. Materials and methods. From October 1997 to September 2002 we studied six patients affected by pseudo-obstruction of the colon. The pseudo-obstruction was recurrent in two cases. Acute dilatation of the colon without radiologically-detectable organic obstruction was the inclusion criterion for the study. Results. Plain abdominal radiography revealed colon dilatation that extended to the splenic flexure in three patients, to the hepatic flexure in two patients, and confined to the transverse colon in one patient. None of the patients showed air-fluid levels of the small intestine. Conclusions. The most relevant clinical finding in Ogilvie's syndrome is abdominal distension, which arises suddenly, has a progressive course and reaches massive levels, The first-line diagnostic investigation is plain abdominal radiography which shows extreme colon dilation without air-fluid levels of the small intestine. In three of our patients, conservative therapy alone was able to restore normal conditions within five days: two patients required decompressive colonoscopy, and one patient died from cardio-circulatory arrest after 48 hours.