Acute Colonic Pseudo-obstruction

Progressive abdominal distention, nausea, constipation, and mild abdominal pain developed in an 82-year-old woman 5 days after she underwent surgical repair of a left hip fracture. Her medical history was significant for Parkinson disease, type 2 diabetes mellitus, and hypertension. Plain abdominal films showed generalized colonic distention (A). A water-soluble contrast enema revealed no mechanical obstruction (B). The patient's white blood cell count was normal; hypokalemia and hyponatremia were detected. Dr Virendra Parikh of Fort Wayne, Ind, reports that acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is characterized by massive dilatation of the colon in the absence of organic mechanical obstruction. Without prompt treatment, the colonic distention may result in perforation, peritonitis, and death. The syndrome may occur with abdominal, pelvic, orthopedic, or urologic surgery and with nonoperative trauma, including fractures, burns, and gynecologic procedures. The distention is associated with dehydration and metabolic derangements. Leukocytosis suggests ischemia of the colon or perforation. Obtain plain abdominal films when this diagnosis is suspected. If mechanical bowel obstruction cannot be excluded, a water-soluble contrast enema needs to be performed. Conservative therapy consists of bowel rest, nasogastric suctioning, correction of fluid and electrolyte imbalance, and discontinuation of all narcotic medications. Gentle enemas and endoscopic decompression may be helpful. Rectal tube and bowel stimulants also may be tried. Surgery is required for patients who have signs of ischemia or perforation. Frequent clinical assessment is mandatory. This patient's regimen included bowel rest, withdrawal of all narcotic medications, total parenteral nutrition for 5 days, correction of electrolyte imbalance, and colonoscopic decompression. Abdominal films were obtained daily to monitor her recovery, which took several days.