Abstract
Four additional cases of Ogilvie's syndrome (acute colonic pseudo-obstruction), representing the first cases described in Italy, are reported. The medical literature concerning the subject is also thoroughly reviewed.
Ogilvie's syndrome is an acute massive dilatation of the large bowel without organic obstruction of the distal colon. Three hundred and fifty-one cases have been described in the literature to date. Eighty-eight per cent of cases were associated with various extracolonic affections (metabolic and organ dysfunctions, postoperative and posttraumatic states, etc.). Twelve per cent of cases were not associated with known disorders and were defined as idiopathic. The pathophysiology of the syndrome is still unknown. Ogilvie, who first described the syndrome in 1948, suggested an imbalance between the sympathetic and parasym-pathetic innervation of the colon: this neurogenic hypothesis has been shared by other authors, although explanations may differ slightly. The clinical and radiologic picture closely resembles mechanical obstruction of the large bowel. The most marked dilatation usually takes place in the right colon and cecum: if the distended cecum reaches a diameter larger than 9 to 12 cm, perforation is likely to occur; if perforation occurs, the mortality rate incrases from 25 to 31 per cent to about 43 to 46 per cent. If conservative management fails to control the dilatation and cecal rupture is impending or suspected emergency surgery is indicated, the surgical procedure of choice is dictated by the general conditions of the patient as well as by the intestinal findings: operation may consist of cecostomy, colostomy, or right hemicolectomy or simply emptying the bowel.
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References
Ogilvie H. Large-intestine colic due to sympathetic deprivation: a new clinical syndrome. Br Med J 1948;2:671–3.
Dunlop JA. Ogilvie's syndrome of false colonic obstruction: a case with post-mortem findings. Br Med J 1949;1:890–1.
Handley RS. Chronic ileus caused by malignant invasion of the posterior abdominal wall. Br Med J 1949;1:891–2.
Macfarlane JA, Kay SK. Ogilvie's syndrome of false colonic obstruction: is it a new clinical entity? Br Med J 1949;2:1267–9.
McCune WS, Keshishian JM. Postoperative intestinal obstruction. Surg Gynecol Obstet 1953;96:567–72.
Cannell DE, Tovee EB. Postpartum obstruction of the large bowel. Postgrad Med 1957;21:231–5.
Dudley HA, Sinclair IS, McLaren IF, McNair TJ, Newsam JE. Intestinal pseudo-obstruction. J R Coll Surg Edinb 1958;3:206–17.
Eckman WG, Wenzke F, Abramson W. Perforation of the cecum complicating adynamic ileus. Am J Surg 1958;96:718–20.
Robertson JA, Eddy WA, Vosseler AJ. Spontaneous perforation of the cecum without mechanical obstruction: review of literature and case report. Am J Surg 1958;96:448–52.
Moore CE, Koman GM. Impending cecal perforation secondary to a crushing injury of the pelvis. Arch Surg 1959;79:1044–6.
Morton JH, Schwartz SI, Gramiak R. Heus of the colon. Arch Surg 1960;81:425–34.
Hirsch MI. Spontaneous rupture of the caecum: report of a case. Cent Afr J Med 1961;7:49.
Stephens FO. The syndrome of intestinal pseudo-obstruction. Br Med J 1962;1:1248–50.
Melamed M, Kubian E. Relationship of the autonomic nervous system to “functional” obstruction of the intestinal tract: report of four cases, one with perforation. Radiology 1963;80:22–9.
Rothwell-Jackson RL. Idiopathic large-bowel obstruction. Br J Surg 1963;80:22–9.
Heitzman EJ, Fulmer CM, Sanborn JC. Paralytic ileus following myocardial infarction. Am J Cardiol 1965;16:887–93.
Millar DR, Øvlisen B. Two cases of spontaneous perforation of the caecum following caesarean section. Acta Obstet Gynecol Scand 1966;45:254–60.
Stephens FO. Intestinal pseudo-obstruction. Med J Aust 1966;1:1026–8.
Bryk D, Soong KY. Colonic ileus and its differential roentgen diagnosis. AJR 1967;104:329–37.
Dumont M, Dovy D. Terforation spontanee du caecum après césarienne. Rev Fr Gynecol Obstet 1967;62:531–3.
Yeo R. Spontaneous perforation of the caecum: case reports and a review of the literature. Postgrad Med J 1967;43:65–7.
Mclamed M, Rabushka SE, Melamed JL. Colon ileus associated with low spine disease. Clin Radiol 1969;20:47–51.
Carrasquilla C, Arbulu A, Fromm S, Lucas C. Cecal perforation due to adynamic ileus. Dis Colon Rectum 1970;13:252–4.
Caves PK, Crockard HA. Pseudo-obstruction of the large bowel. Br Med J 1970;2:583–6.
Gillett DJ. Non-mechanical large-bowel obstruction. Aust NZ J Surg 1971;41:47–50.
Leventhal ML, Evans R, Levin B. Acute segmental dilatation of the cecum without mechanical obstruction following cesarean section. Am J Obstet Gynecol 1971;110:538–42.
Wanebo H, Mathewson C, Conolly B. Pseudo-obstruction of the colon. Surg Gynecol Obstet 1971;133:44–8.
Jensen HK. Spontaneous perforation of the caecum following caesarean section: report of a case and review of the literature. Acta Obstet Gynecol Scand 1972;51:381–3.
Muggia AL. Perforation of the cecum associated with hypokalemic ileus: report of a case. Am J Gastroenterol 1972;57:169–71.
Wojtalik RS, Lindenauer SM, Kahn SS. Perforation of the colon associated with adynamic ileus. Am J Surg 1973;125:601–6.
Adams JT. Adynamic ileus of the colon: an indication for cecostomy. Arch Surg 1974;109:503–7.
Bardsley D. Pseudo-obstruction of the large bowel. Br J Surg 1974;61:963–9.
Chaimoff C, Dintsman M. The pseudo-obstruction of bowel syndrome: a suggestion of a simple surgical remedy. Am J Proctol 1974;Feb 25:39–47.
Goldstein HM, Babu SS. Colonic ileus: an atypical form of adynamic ileus. JAMA 1974;230:1008–9.
McCormack M. Caecal rupture in psychotic patients. Br Med J 1974;4:82–3.
Norton L, Young D, Scribner R. Management of pseudo-obstruction of the colon. Surg Gynecol Obstet 1974;138:595–8.
Gierson ED, Storm FK, Shaw W, Coyne SK. Caecal rupture due to colonic ileus. Br J Surg 1975;62:383–6.
Golden GT, Chandler JG. Colonic ileus and cecal perforation in patients requiring mechanical ventilatory support. Chest 1975;68:661–4.
Koikkalainen K, Jarvinen A. Spontaneous perforation of the proximal colon following lung surgery. Ann Chir Gynaecol 1975;64:18–21.
Hay JM, Kaswin R, Trémolières F, Maillard JN. Perforations caecales au cours des dilatations idiopathiques aiguës du colon. Nouv Presse Med 1976;5:16–8.
Spira IA, Rodrigues R, Wolff WI. Pseudo-obstruction of the colon. Am J Gastroenterol 1976;65:397–408.
Spira IA, Wolff WI. Colonic pseudo-obstruction following termination of pregnancy and uterine operation. Am J Obstet Gynecol 1976;126:7–12.
Kukora JS, Dent TL. Colonoscopic decompression of massive nonobstructive cecal dilation. Arch Surg 1977;112:512–7.
Macmanus Q, Krippaehne WW. Diastatic perforation of the cecum without distal obstruction: case report and review of the literature. Arch Surg 1977;112:1227–30.
Meyers MA. Colonic ileus. Gastrointest Radiol 1977;2:37–40.
Søreide O, Bjerkeset T, Fossdal JE. Pseudo-obstruction of the colon (Ogilvie's syndrome), a genuine clinical condition? review of the literature (1948–1975) and report of five cases. Dis Colon Rectum 1977;20:487–91.
Bachulis BL, Smith PE. Pseudoobstruction of the colon. Am J Surg 1978;136:66–72.
Carda Abella P, Die Govanes A, Nuñez Puertas A, Valle Sanchiz J. Perforaciòn del ciego en la dilataciòn pseudoobstructiva del colon. Rev Esp Enferm Apar Dig 1978;53:333–40.
Desouches G, Bastien J, Joublin M. Dilatation colique idiopathique aiguë et perforation caecale au cours d'une septicémie à streptocoque. Gastroenterol Clin Biol 1978;2:185–8.
Leborgne J, Pannier M, Le Neel JC. Perforation du coecum, complication d'une dilatation aiguë idiopathique du côlon ou syndrome d'Ogilvie. Intérêt pratique de quelques données pathogéniques: a propos d'un cas. Ann Chir 1978;32:187–90.
Lescher TJ, Teegarden DK, Pruitt BA Jr. Acute pseudo-obstruction of the colon in thermally injured patients. Dis Colon Rectum 1978;21:618–22.
Melzig EP, Terz JJ. Pseudo-obstruction of the colon. Arch Surg 1978;113:1186–90.
Rudigoz RC, Berard P. Les colectasies idiopathiques aiguës. Traitement prophylactique de la perforation coecale. Lyon Med 1978;239:275–8.
Abcarian H, Eftaiha M, Kraft AR, Nyhus LM. Colonic complications of acute pancreatitis. Arch Surg 1979;114:995–1001.
Baker DA, Morin ME, Tan A, Sue HK. Colonic ileus: indication for prompt decompression. JAMA 1979;241:2633–4.
Bosiljevac JE. Spastic ileus. J Kans Med Soc 1979;80:251–5.
Brun M. Discussion. Lyon Chir 1979;75:372.
Dimyan WA, Robb JE, Macpherson S. Intestinal pseudo-obstruction (letter to editor). Lancet 1979;1:880.
Fletcher JP, Little JM. Intestinal pseudo-obstruction. Med J Aust 1979;2:339–41.
Karani J, Veale D, Rake MO. Intestinal pseudo-obstruction in alcohol abuse: report of two cases. Br Med J 1979;2:1400.
Passail G, Benacerraf R. Les pseudo-occlusions aiguës du côlon. Ann Radiol (Paris) 1979;22:508–14.
Rubenstein RB, Lantz J, Stevens K, Spira IA. Uremic ileus: uremia presenting colonic obstruction. NY State J Med 1979;79:248–9.
Shaxted EJ, Jukes R. Pseudo-obstruction of the bowel in pregnancy: case reports. Br J Obstet Gynaecol 1979;86:411–3.
Vignal J, Tavin B, Grandjean JP, Daubricourt M. La dilatation aiguë idiopathique du côlon. Lyon Chir 1979;75:370–2.
Villar HV, Norton LW. Massive Cecal dilation: pseudoobstruction versus cecal volvulus. Am J Surg 1979;137:170–4.
Attiyeh FF, Knapper WH. Pseudo-obstruction of the colon (Ogilvie's syndrome). Dis Colon Rectum 1980;23:106–8.
Editorial. Intestinal pseudo-obstruction. Br Med J 1973;1:64–5.
Editorial. Intestinal pseudo-obstruction. Lancet 1979;1:535–6.
Last RD. Caecal rupture in psychotic patients (correspondence). Br Med J 1974;4:407.
Byrne JJ. Unusual aspects of large bowel obstruction. Am J Surg 1962;103:62–5.
Melamed M, Melamed JL, Rabushka SE. Appendicitis: “functional” bowel obstruction associated with perforation of the appendix. AJR 1967;99:112–7.
Welch JP. Acute large-intestinal obstruction as the inital sign of pancreatic carcinoma. Dis Colon Rectum 1979;22:425–7.
Al-Jurf AS. Pseudo-obstruction in idiopathic megacolon. Dis Colon Rectum 1979;22:437–9.
Melamed M, Pantone AM, Williams J. Adult megacolon with-out obstruction. IMJ 1960;118:31–2.
Spira IA, Wolff WI. Gangrene and spontaneous perforation of the cecum as a complication of pseudo-obstruction of the colon: report of three cases and speculation as to etiology. Dis Colon Rectum 1976;19:557–62.
Lowman RM, Davis L. An evaluation of cecal size in impending perforation of the cecum. Surg Gynecol Obstet 1956;103:711–8.
Stillwell GK. The law of Laplace: some clinical applications. Mayo Clin Proc 1973;48:863–9.
Euphrat EJ. Adynamic ileus of the colon (letter to editor). Arch Surg 1975;110:224–5.
Ferguson JH, Cameron A. Intestinal pseudo-obstruction (correspondence). Br Med J 1973;1:614.
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Nanni, C., Garbini, A., Luchetti, P. et al. Ogilvie's syndrome (acute colonic pseudo-obstruction):. Dis Colon Rectum 25, 157–166 (1982). https://doi.org/10.1007/BF02553265
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DOI: https://doi.org/10.1007/BF02553265