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Acute Colonic Pseudo-Obstruction (ACPO): Ogilvie’s Syndrome

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Clinical Decision Making in Colorectal Surgery


Acute colonic pseudo-obstruction is defined as massive dilation of the colon without mechanical obstruction. The incidence is approximately 100 cases per 100,000 inpatient admissions, and is most often precipitated by illness or surgery. Perforation is rare; the vast majority of patients recover with conservative measures such as bowel rest and decompression, opioid avoidance, and mobilization. In general, more aggressive intervention should be instituted if cecal diameter is greater than 12 cm, or dilation has persisted beyond 2 days without improvement. Pharmacologic stimulation with neostigmine should be attempted first. If this intervention is unsuccessful, endoscopic decompression should be employed. In the rare cases that all other measures fail, definitive decompression is required.

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Suggested Reading

  • Geller A, Peterson BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc. 1996;44(2):144–50.

    Article  CAS  PubMed  Google Scholar 

  • Harig JM, Fumo DE, Loo FD, Parker HJ, Soergel KH, Helm JF, Hogan WJ. Treatment of acute nontoxic megacolon during colonoscopy: tube placement versus simple decompression. Gastrointest Endosc. 1988;34(1):23–7.

    Article  CAS  PubMed  Google Scholar 

  • Johnson CD, Rice RR, Kelvin FM, Foster WL, Williford ME. The radiologic evaluation of gross cecal distention: emphasis on cecal ileus. AJR Am J Roentgenol. 1985;145(6):1211–7.

    Article  CAS  PubMed  Google Scholar 

  • Kukora JS, Dent TL. Colonoscopic decompression of massive nonobstructive cecal dilatation. Arch Surg. 1977;112(4):512–7.

    Article  CAS  PubMed  Google Scholar 

  • Loftus CG, Harewood GC, Baron TH. Assessment of predictors of response to neostigmine for acute colonic pseudo-obstruction. Am J Gastroenterol. 2002;97(12):3118–22.

    Article  CAS  PubMed  Google Scholar 

  • Maloney N, Vargas HD. Acute intestinal pseudo-obstruction (Ogilvie’s syndrome). Clin Colon Rectal Surg. 2005;18(2):96–101.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ogilvie H. Large-intestine colic due to sympathetic deprivation. Br Med J. 1948;2(4579):671–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med. 1999;341(3):137–41.

    Article  CAS  PubMed  Google Scholar 

  • Ramage JI, Baron TH. Percutaneous endoscopic cecostomy: a case series. Gastrointest Endosc. 2003;57(6):752–5.

    Article  PubMed  Google Scholar 

  • Ross SW, Oommen B, Wormer BA, Walter AL, Augenstein VA, Heniford BT, Sing RF, Christmas AB. Acute colonic pseudo-obstruction: defining the epidemiology, treatment and adverse outcomes of Ogilvie’s syndrome. Am Surg. 2016;82(2):102–11.

    PubMed  Google Scholar 

  • Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol. 2007;21(4):671–87.

    Article  PubMed  Google Scholar 

  • Saunders MD, Kimmey MB. Systematic review: acute colonic pseudo-obstruction. Aliment Pharmacol Ther. 2005;22(10):917–25.

    Article  CAS  PubMed  Google Scholar 

  • Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon. Dis Colon Rectum. 1986;29(3):203–10.

    Article  CAS  PubMed  Google Scholar 

  • Vogel JD, Feingold DL, Stewart DB, Turner JS, Boutros M, Chun J, Steele SR. Clinical practice guidelines for colon volvulus and acute colonic pseudo-obstruction. Dis Colon Rectum. 2016;59(7):589–600.

    Article  PubMed  Google Scholar 

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Correspondence to David A. Etzioni .

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Powell, A.C., Etzioni, D.A. (2020). Acute Colonic Pseudo-Obstruction (ACPO): Ogilvie’s Syndrome. In: Steele, S., Maykel, J., Wexner, S. (eds) Clinical Decision Making in Colorectal Surgery. Springer, Cham.

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