5. Clinical course
07/16 Neostigmine X 3 days
07/19 KUB: massive colonic and intestinal gas
07/20 on rectal tube
07/21 remove of rectal tube
07/27 NPO
08/01 NG feeding with Nupep 1500kcal/1500ml
6. Ogilvie syndrome
Acute colonic pseudo-obstruction
Definition
Colonic dilation without mechanical obstruction
s/s: abdominal distension without pain
Plain film: massive colonic dilation, esp. of the
cecum and right colon
If not decompressed the colon, patient risks
perforation, peritonitis, and death.
7.
8. Pathophysiology
not clearly understood
It is thought to result from an imbalance in the
regulation of colonic motor activity by the
autonomic nervous system.
parasympathetic nervous dysfunction
9. Causes
Ogilvie syndrome is usually associated with a recent,
significant medical illness or surgical procedure.
Recent surgery
Severe pulmonary disease
Severe cardiovascular disease
Severe electrolyte disturbance
Severe constipation
Malignancy
Systemic infection
Medications
10. Treatment
Medical Care
Supportive care (NPO, NG decompression, fluid
resuscitation, enema)
neostigmine
Colonoscopic decompression of the colon
Surgical Care
Tube cecostomy
Subtotal colectomy
11. Neostigmine for the treatment of
acute colonic pseudo-obstruction
NEJM 1999; 341 (3):137
12. Patients and Methods
Patient en-roll criteria:
Abdominal distention and radiographic evidence of colonic
dilation (cecal diameter > 10 cm)
had no response to at least 24 hours of conservative
treatment.
Exclusion criteria:
Basal HR < 60 bpm, SBP < 90 mmHg
active bronchospasm
pregnancy
a history of colon cancer or partial colonic resection
active GI bleeding
signs of bowel perforation
13. Patients and methods
Randomly assigned 11 to receive neostigmine (2mg, iv)
and 10 to receive saline.
Assessment of Outcomes
clinical response
prompt evacuation of flatus or stool
a reduction in abdominal distention
measurements of the colon on radiographs
Patients who had no response to the initial injection were
eligible to receive openlabel neostigmine three hours
later.
14.
15.
16.
17. Conclusion & Discussion
The use of neostigmine should be careful in patient
underlying:
bradyarrhythmias
bronchospasm
renal impairment
The effect of neostigmine treatment, compare with
conservative therapy
Colonoscopy
Surgery
18. Discussion
Even though the elimination half-life of neostigmine is
short, most patients had sustained improvement.
Concomitant treatment with neostigmine and the
anticholinergic agent glycopyrrolate has been reported
to diminish the central cholinergic effects of neostigmine
without reducing the increases in colonic motility.
19. Ogilvie Syndrome as a
Postoperative Complication
Arch Surg. 2000;135:682-687
20. Patients and methods
Trauma or operation between 1989 and 1998
Radiographic findings:
colonic distention greater than 8 cm without evidence
of mechanical obstruction
Patients who had small-bowel dilation in addition
to colonic dilation were considered to have a
postoperative ileus and were excluded from the
study
21. Patients and methods
Type of operation
Postoperative day of diagnosis of Ogilvie
syndrome
Interval from diagnosis to resolution or death
Treatment
24. Results
Conservative treatment (nasogastric tube placement,
fluid resuscitation, and enemas) was successful in 19
patients (53%).
12 of the 13 patients (92%) had successful
decompression of the colon after the initial colonoscopy
The mortality rate
Total=14% (5/36)
Required operative intervention= 60% (3/5)