Introduction:
Acute colonic pseudo-obstruction is also known as Ogilvie syndrome or colonic pseudo-obstruction. It was first discovered in 1948 by British surgeon Sir William Ogilvie. It is a rare acquired disorder characterized by abnormalities affecting the rhythmic muscular contractions and involuntary actions within the colon. Peristalsis movement passes food through the gastrointestinal tract in digestive organs with the coordination of muscles, nerves, and hormones.
The symptoms of acute colonic pseudo-obstruction are similar to other intestinal pseudo-obstruction, including nausea, vomiting, swelling of the abdominal region, abdominal bloating, and constipation. The symptoms are similar to mechanical obstruction of the large intestine, but there is no physical obstruction; that is why it is known as pseudo-obstruction.
The mechanical obstructions include conditions such as tumors or scar tissues that can block the colon's passage. Ogilvie syndrome (acute colonic pseudo-obstruction) is always associated with an underlying disorder, trauma, or surgery (leading to scar tissue). The treatment for acute colonic pseudo-obstruction can be conservative, but if left unrecognized or untreated, it can lead to serious life-threatening complications.
What Are the Causes of Acute Colonic Pseudo-Obstruction?
The exact cause behind Oligvie syndrome or acute colonic pseudo-obstruction is not understood and is controversial; however, the disorder often affects an individual with a current medical condition that was serious or any surgical procedure. However, some conditions and infections are known as the underlying cause of acute colonic pseudo-obstruction.
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Three common conditions are associated with acute colonic pseudo-obstruction: infections, operative trauma, and heart diseases. Heart disease includes a heart attack or myocardial infarction.
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Pneumonia and sepsis are associated with acute colonic pseudo-obstruction or Ogilvie syndrome.
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Surgeries that are known to be associated with Ogilvie syndrome are abdominal surgery, orthopedic surgeries (particularly total hip replacement), neurological surgeries (including the brain and nervous system), and urologic and cardiac surgery (heart).
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Some diseases, such as pulmonary diseases, kidney diseases, respiratory failures, malignancy, metabolic disorders, and severe electrolyte imbalances, are associated with acute colonic pseudo-obstruction.
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Consumption of some medicines, such as anticholinergics, amphetamines, steroids, or narcotics, can also lead to acute colonic pseudo-obstruction.
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Ogilvie syndrome, or acute colonic pseudo-obstruction, is caused due to abnormalities in the autonomic nervous system, which is responsible for controlling the motor function of the colon.
What Are the Symptoms Seen in Acute Colonic Pseudo-Obstruction?
The symptoms of Ogilvie syndrome vary from one patient to another. However, it can be severe and life-threatening and usually occurs in already hospitalized patients who have undergone surgery.
The common symptoms of acute colonic pseudo-obstruction or Ogilvie syndrome are:
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Abdominal pain, bloating, nausea, vomiting, and swelling in the abdomen.
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In addition, some patients suffer from chronic constipation, which eventually gets serious.
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Although abdominal distension may take several days to develop, it can also develop rapidly within 24 hours of disease.
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Other symptoms include fever, increased WBC (white blood cell) count in the body, and abdominal tenderness.
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In severe conditions, ischemia and perforation in the colon can lead to the spilling out of the colon's contents. A perforated abdominal cavity may cause fever, abdominal pain, sepsis, and severe blood infection. The cecum of the large intestine is at the most risk of developing perforation.
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Ischemia of the colon leads to tissue damage and death of the affected large intestine region.
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In several cases of ischemia and perforation, there is inflammation of the peritoneum (tissue that lines the inside of the abdominal wall), known as peritonitis.
Which Population Is Affected by Acute Colonic Pseudo-Obstruction?
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Ogilvie syndrome or acute colonic pseudo-obstruction can affect both males and females, but the more affected population is males.
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The age group affected mainly by the obstruction is the late middle (around 60); however, Ogilvie syndrome can affect any age group.
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The condition is seen more commonly in people hospitalized due to an acute illness or surgery.
How to Diagnose Acute Colonic Pseudo-Obstruction?
The diagnosis of acute colonic pseudo-obstruction or Ogilvie syndrome depends on the patient’s detailed history, observed symptoms, and various specialized tests.
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An X-ray of the colon is done to rule out the presence of any mechanical obstruction. If the radiograph reveals an expanded or dilated colon or abnormal air-fluid levels in the small bowel, it indicates intestinal obstruction.
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Computed tomography or a water-soluble enema should be performed to help to rule out a mechanical obstruction in cases where gas and distension are not present throughout the colon. In cases of water-soluble enema, dye is inserted into the large intestine through a soft and thin tube through the rectum, and X-rays are taken.
What Can Be the Treatment for Acute Colonic Pseudo-Obstruction?
The therapeutic options for Ogilvie syndrome include medications, decompression, support therapy, and surgeries. The therapeutic procedures depend on factors such as the progression of the disease, symptoms present, the condition of the bowel, and the individual's age.
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In cases of perforation and ischemia, immediate treatment is necessary, which may also include surgery.
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In cases such as cardiac diseases which lead to acute colonic pseudo-obstruction, it is crucial to treat the underlying cause first.
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Supportive therapy for acute colonic pseudo-obstruction includes avoiding oral food and fluid intake and administering intravenous fluids to maintain the electrolyte and fluid balance in the body. Use nasogastric suction to restrict the amount of air swallowed to avoid further expansion of the colon. A long thin tube is inserted into the rectum, which helps pass air and stool.
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According to studies, the drug Neostigmine can be given in acute colonic pseudo-obstruction cases, leading to rapid colon decompression. This is because neostigmine increases acetylcholine's activity time, which helps in the communication of the nerve and the muscles.
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Colonic Decompression: This procedure is used to decompress the colon and help reduce the pressure within the colon.
Conclusion:
Acute colonic pseudo-obstruction is a disorder with a physical obstruction in the large intestine, making it difficult for food and particles to cross the colon. In severe cases, it leads to symptoms such as nausea, vomiting, chronic constipation, and ischemia. Therefore, the treatment is vital as it may lead to severe infection and perforation.
