Ogilvie's syndrome - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:49:01Z

Prepared the page for translation

← Older revision		Revision as of 23:49, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*Also known as acute colonic pseudo-obstruction (ACPO)		*Also known as acute colonic pseudo-obstruction (ACPO)
	*Defined as a [[large bowel obstruction]] (LBO) in which no obstructing lesion can be identified		*Defined as a [[Special:MyLanguage/large bowel obstruction\|large bowel obstruction]] (LBO) in which no obstructing lesion can be identified
	*No definite etiology identified: suspected to develop secondary to a disbalance of colonic autonomic regulatory control		*No definite etiology identified: suspected to develop secondary to a disbalance of colonic autonomic regulatory control
	*Predisposing factors: recent surgery, underlying neurologic disorders, critical illness		*Predisposing factors: recent surgery, underlying neurologic disorders, critical illness
	*First described in 1948 by Sir Ogilvie, in two patients with retroperitoneal malignancy and acute colonic pseudo-obstruction		*First described in 1948 by Sir Ogilvie, in two patients with retroperitoneal malignancy and acute colonic pseudo-obstruction


	==Clinical Features==		==Clinical Features==


	===History===		===History===

	*Typically present in patients with concomitant acute comorbid conditions		*Typically present in patients with concomitant acute comorbid conditions
	**Commonly: significant spinal or retroperitoneal [[abdominal trauma\|trauma]]		**Commonly: significant spinal or retroperitoneal [[Special:MyLanguage/abdominal trauma\|trauma]]
	**Also: significant [[electrolyte imbalances]], significant [[opioid]] exposure		**Also: significant [[Special:MyLanguage/electrolyte imbalances\|electrolyte imbalances]], significant [[Special:MyLanguage/opioid\|opioid]] exposure
	*Presenting signs and symptoms are the same as [[large bowel obstruction:		*Presenting signs and symptoms are the same as [[large bowel obstruction:
	**[[Abdominal pain]]/distension		**[[Abdominal pain\|large bowel obstruction:
			**[[Special:MyLanguage/Abdominal pain]]/distension
	**Obstipation		**Obstipation
	***In contrast to mechanical obstruction, 40-50% will continue to pass flatus		***In contrast to mechanical obstruction, 40-50% will continue to pass flatus
	**[[Vomiting]]		**[[Special:MyLanguage/Vomiting\|Vomiting]]


	===Physical Exam===		===Physical Exam===

	*Dilated bowel may be palpable		*Dilated bowel may be palpable
	*Findings suggestive of [[dehydration]], [[sepsis]], and gangrene/perforation may be present, depending on the extent of progression		*Findings suggestive of [[Special:MyLanguage/dehydration\|dehydration]], [[Special:MyLanguage/sepsis\|sepsis]], and gangrene/perforation may be present, depending on the extent of progression
	*[[peritonitis\|Peritoneal]] signs and fever suggest perforation		*[[Special:MyLanguage/peritonitis\|Peritoneal]] signs and fever suggest perforation


	==Differential Diagnosis==		==Differential Diagnosis==

	*Malignancy (commonly, colorectal cancer)		*Malignancy (commonly, colorectal cancer)
	*[[diverticulitis\|Diverticular disease]]		*[[Special:MyLanguage/diverticulitis\|Diverticular disease]]
	*Compression from metastatic disease		*Compression from metastatic disease
	*Impaction		*Impaction
	*Strictures (IBD, chronic colonic ischemia)		*Strictures (IBD, chronic colonic ischemia)
	*Adhesions		*Adhesions
	*[[Hernia]]		*[[Special:MyLanguage/Hernia\|Hernia]]
	*[[Toxic megacolon]]		*[[Special:MyLanguage/Toxic megacolon\|Toxic megacolon]]
	*[[Ischemic colitis]]		*[[Special:MyLanguage/Ischemic colitis\|Ischemic colitis]]
	*Adynamic [[ileus]] of the large and small bowel		*Adynamic [[Special:MyLanguage/ileus\|ileus]] of the large and small bowel

			</translate>
	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Ogilvie ct coronal.jpg\|thumb\|CT-Scan showing a coronal section of the abdomen of an elderly woman with Ogilvie syndrome.]]		[[File:Ogilvie ct coronal.jpg\|thumb\|CT-Scan showing a coronal section of the abdomen of an elderly woman with Ogilvie syndrome.]]

	===Work-up===		===Work-up===
	Same as [[Bowel obstruction\|bowel obstruction]]
			Same as [[Special:MyLanguage/Bowel obstruction\|bowel obstruction]]
	*Labs:		*Labs:
	**CBC: significant leukocytosis may indicate sepsis/gangrene/perforation		**CBC: significant leukocytosis may indicate sepsis/gangrene/perforation
	**Electrolyte Panel: guides rehydration		**Electrolyte Panel: guides rehydration
	*Imaging: See Clinical Features above		*Imaging: See Clinical Features above
	**[[Abdominal Xray]]		**[[Special:MyLanguage/Abdominal Xray\|Abdominal Xray]]
	***distended colon		***distended colon
	***small bowel distension possible		***small bowel distension possible
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	***may also be therapeutic		***may also be therapeutic
	**Colonoscopy: also diagnostic and therapeutic		**Colonoscopy: also diagnostic and therapeutic


	==Management==		==Management==


	===Cecal distention <12cm, no evidence of gangrene or perforation===		===Cecal distention <12cm, no evidence of gangrene or perforation===

	''consider conservative management''		''consider conservative management''
	*Surgical consult		*Surgical consult
	*Bowel rest/decompression [NPO, [[NG tube]], rectal tube]		*Bowel rest/decompression [NPO, [[Special:MyLanguage/NG tube\|NG tube]], rectal tube]
	*[[volume repletion\|Rehydration]]/[[Electrolyte repletion]]		*[[Special:MyLanguage/volume repletion\|Rehydration]]/[[Special:MyLanguage/Electrolyte repletion\|Electrolyte repletion]]
	*[[analgesia\|Pain management]] [No opioids]		*[[Special:MyLanguage/analgesia\|Pain management]] [No opioids]
	*Management of comorbid conditions		*Management of comorbid conditions
	*[[Neostigmine]] then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases		*[[Special:MyLanguage/Neostigmine\|Neostigmine]] then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases
	**Neostigmine for cecal diameter >10cm		**Neostigmine for cecal diameter >10cm
	**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>		**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>
	**Exclude patient with HR<60, low SBP, peritoneal signs		**Exclude patient with HR<60, low SBP, peritoneal signs


	===Cecal distension >12cm '''OR''' evidence of gangrene/perforation===		===Cecal distension >12cm '''OR''' evidence of gangrene/perforation===

	*Emergent surgical consult		*Emergent surgical consult
	*[[Antibiotics]]		*[[Special:MyLanguage/Antibiotics\|Antibiotics]]


	==Disposition==		==Disposition==

	*Admit		*Admit


	===Complications===		===Complications===

	*Untreated, Ogilvie’s Syndrome leads to the same pathologic changes as any mechanical large bowel obstruction: increasing bowel dilation and distension, dehydration, edema and eventual ischemia and necrosis of the bowel wall, bacterial translocation and sepsis, and eventual bowel wall perforation.		*Untreated, Ogilvie’s Syndrome leads to the same pathologic changes as any mechanical large bowel obstruction: increasing bowel dilation and distension, dehydration, edema and eventual ischemia and necrosis of the bowel wall, bacterial translocation and sepsis, and eventual bowel wall perforation.
	*Cecal perforation is rare: 1-3%		*Cecal perforation is rare: 1-3%


	==See Also==		==See Also==
	*[[Abdominal Pain]]
	*[[Bowel Obstruction]]		*[[Special:MyLanguage/Abdominal Pain\|Abdominal Pain]]
			*[[Special:MyLanguage/Bowel Obstruction\|Bowel Obstruction]]


	==External Links==		==External Links==
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	==References==		==References==

	<references/>		<references/>


	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: /* Evaluation */

2021-07-08T22:03:31Z

Evaluation

← Older revision		Revision as of 22:03, 8 July 2021
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	==Evaluation==		==Evaluation==
			[[File:Ogilvie ct coronal.jpg\|thumb\|CT-Scan showing a coronal section of the abdomen of an elderly woman with Ogilvie syndrome.]]
	===Work-up===		===Work-up===
	Same as [[Bowel obstruction\|bowel obstruction]]		Same as [[Bowel obstruction\|bowel obstruction]]

ClaireLewis at 23:19, 29 September 2019

2019-09-29T23:19:25Z

← Older revision		Revision as of 23:19, 29 September 2019
Line 9:		Line 9:
	===History===		===History===
	*Typically present in patients with concomitant acute comorbid conditions		*Typically present in patients with concomitant acute comorbid conditions
	**Commonly: significant spinal or retroperitoneal trauma		**Commonly: significant spinal or retroperitoneal [[abdominal trauma\|trauma]]
	**Also: significant electrolyte imbalances, significant opioid exposure		**Also: significant [[electrolyte imbalances]], significant [[opioid]] exposure
	*Presenting signs and symptoms are the same as large bowel: [[~~abdominal~~ pain]], distension~~, obstipation, [[vomiting]]~~		*Presenting signs and symptoms are the same as [[large bowel obstruction:
	**In contrast to mechanical obstruction, 40-50% will continue to pass flatus		**[[Abdominal pain]]/distension
			**Obstipation
			***In contrast to mechanical obstruction, 40-50% will continue to pass flatus
			**[[Vomiting]]

	===Physical Exam===		===Physical Exam===
	*Dilated bowel may be palpable		*Dilated bowel may be palpable
	*Findings suggestive of dehydration, sepsis, and gangrene/perforation may be present, depending on the extent of progression		*Findings suggestive of [[dehydration]], [[sepsis]], and gangrene/perforation may be present, depending on the extent of progression
	*Peritoneal signs and fever suggest perforation		*[[peritonitis\|Peritoneal]] signs and fever suggest perforation

	==Differential Diagnosis==		==Differential Diagnosis==
	*Malignancy (commonly, colorectal cancer)		*Malignancy (commonly, colorectal cancer)
	*Diverticular disease		*[[diverticulitis\|Diverticular disease]]
	*Compression from metastatic disease		*Compression from metastatic disease
	*Impaction		*Impaction
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	*Adhesions		*Adhesions
	*[[Hernia]]		*[[Hernia]]
	*Toxic megacolon		*[[Toxic megacolon]]
	*[[Ischemic colitis]]		*[[Ischemic colitis]]
	*Adynamic ileus of the large and small bowel		*Adynamic [[ileus]] of the large and small bowel

	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
Line 36:		Line 39:
	===Work-up===		===Work-up===
	Same as [[Bowel obstruction\|bowel obstruction]]		Same as [[Bowel obstruction\|bowel obstruction]]

	*Labs:		*Labs:
	**CBC: significant leukocytosis may indicate sepsis/gangrene/perforation		**CBC: significant leukocytosis may indicate sepsis/gangrene/perforation
	**Electrolyte Panel: guides rehydration		**Electrolyte Panel: guides rehydration
	*Imaging: See Clinical Features above		*Imaging: See Clinical Features above
	**Abdominal XR		**[[Abdominal Xray]]
			***distended colon
			***small bowel distension possible
			***cecal diameter >12cm indicates high risk of perforation
	**CT		**CT
			***dilation of the large bowel, often without an abrupt transition point
			***no mechanically obstructing lesion
			***gradual transition point is commonly identified at or near the splenic flexure
	**Water soluble contrast enema		**Water soluble contrast enema
	**Colonoscopy		***diagnostic: rules out mechanical obstruction
			***may also be therapeutic
	~~===Evaluation===~~		**Colonoscopy: also diagnostic and therapeutic
	*Abdominal XR:
	**distended colon
	**small bowel distension possible
	**cecal diameter >12cm indicates high risk of perforation
	*CT:
	**dilation of the large bowel, often without an abrupt transition point
	**no mechanically obstructing lesion
	**gradual transition point is commonly identified at or near the splenic flexure
	*Water soluble contrast enema:
	**diagnostic: rules out mechanical obstruction
	**may also be therapeutic
	*Colonoscopy: also diagnostic and therapeutic

	==Management==		==Management==
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	''consider conservative management''		''consider conservative management''
	*Surgical consult		*Surgical consult
	*Bowel rest/decompression [NPO, NG tube, ~~Rectal~~ tube]		*Bowel rest/decompression [NPO, [[NG tube]], rectal tube]
	*Rehydration/Electrolyte ~~Repletion~~		*[[volume repletion\|Rehydration]]/[[Electrolyte repletion]]
	*Pain management [No opioids]		*[[analgesia\|Pain management]] [No opioids]
	*Management of comorbid conditions		*Management of comorbid conditions
	*Neostigmine then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases		*[[Neostigmine]] then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases
	**Neostigmine for cecal diameter >10cm		**Neostigmine for cecal diameter >10cm
	**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>		**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T23:01:04Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 23:01, 30 May 2017
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	**Exclude patient with HR<60, low SBP, peritoneal signs		**Exclude patient with HR<60, low SBP, peritoneal signs

	===Cecal distension >12cm OR evidence of gangrene/perforation===		===Cecal distension >12cm '''OR''' evidence of gangrene/perforation===
	*Emergent surgical consult		*Emergent surgical consult
	*[[Antibiotics]]		*[[Antibiotics]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T22:16:35Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 22:16, 24 July 2016
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	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}

	==~~Diagnosis~~==		==Evaluation==
	===Work-up===		===Work-up===
	Same as [[Bowel obstruction\|bowel obstruction]]		Same as [[Bowel obstruction\|bowel obstruction]]

ClaireLewis: /* Cecal distention <12cm, no evidence of gangrene or perforation */

2016-07-14T00:44:24Z

Cecal distention <12cm, no evidence of gangrene or perforation

← Older revision		Revision as of 00:44, 14 July 2016
Line 66:		Line 66:
	*Bowel rest/decompression [NPO, NG tube, Rectal tube]		*Bowel rest/decompression [NPO, NG tube, Rectal tube]
	*Rehydration/Electrolyte Repletion		*Rehydration/Electrolyte Repletion
	*Pain management [No ~~narcotics~~]		*Pain management [No opioids]
	*Management of comorbid conditions		*Management of comorbid conditions
	*Neostigmine then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases		*Neostigmine then endoscopic decompression may be attempted after 24hrs of failed conservative treatment; surgery for refractory cases

ClaireLewis: /* History */

2016-07-14T00:43:59Z

History

← Older revision		Revision as of 00:43, 14 July 2016
Line 10:		Line 10:
	*Typically present in patients with concomitant acute comorbid conditions		*Typically present in patients with concomitant acute comorbid conditions
	**Commonly: significant spinal or retroperitoneal trauma		**Commonly: significant spinal or retroperitoneal trauma
	**Also: significant electrolyte imbalances, significant ~~narcotic~~ exposure		**Also: significant electrolyte imbalances, significant opioid exposure
	*Presenting signs and symptoms are the same as ~~LBO~~: abdominal pain, distension, obstipation, vomiting		*Presenting signs and symptoms are the same as large bowel: [[abdominal pain]], distension, obstipation, [[vomiting]]
	**In contrast to mechanical obstruction, 40-50% will continue to pass flatus		**In contrast to mechanical obstruction, 40-50% will continue to pass flatus

	===Physical Exam===		===Physical Exam===

Neil.m.young: Text replacement - "== " to "=="

2016-07-06T19:43:31Z

Text replacement - "== " to "=="

← Older revision		Revision as of 19:43, 6 July 2016
Line 7:		Line 7:

	==Clinical Features==		==Clinical Features==
	===History===		===History===
	*Typically present in patients with concomitant acute comorbid conditions		*Typically present in patients with concomitant acute comorbid conditions
	**Commonly: significant spinal or retroperitoneal trauma		**Commonly: significant spinal or retroperitoneal trauma

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-02T16:23:26Z

Text replacement - " pt " to " patient "

← Older revision		Revision as of 16:23, 2 July 2016
Line 71:		Line 71:
	**Neostigmine for cecal diameter >10cm		**Neostigmine for cecal diameter >10cm
	**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>		**2-2.5mg neostigmine IV over 5min<ref>Maloney N and Vargas HD. Acute Intestinal Pseudo-Obstruction (Ogilvie's Syndrome). Clin Colon Rectal Surg. 2005 May; 18(2): 96–101.</ref>
	**Exclude pt with HR<60, low SBP, peritoneal signs		**Exclude patient with HR<60, low SBP, peritoneal signs

	===Cecal distension >12cm OR evidence of gangrene/perforation===		===Cecal distension >12cm OR evidence of gangrene/perforation===

Rossdonaldson1: /* Cecal distension >12cm or evidence of gangrene/perforation */

2016-05-14T04:39:59Z

Cecal distension >12cm or evidence of gangrene/perforation

← Older revision		Revision as of 04:39, 14 May 2016
Line 73:		Line 73:
	**Exclude pt with HR<60, low SBP, peritoneal signs		**Exclude pt with HR<60, low SBP, peritoneal signs

	===Cecal distension >12cm or evidence of gangrene/perforation===		===Cecal distension >12cm OR evidence of gangrene/perforation===
	*Emergent surgical consult		*Emergent surgical consult
	*[[Antibiotics]]		*[[Antibiotics]]