Ogilvie’s syndrome—is there a cutoff diameter to proceed with upfront surgery?

Purpose Although Ogilvie’s syndrome was first described about 70 years ago, its etiology and pathogenesis are still not fully understood. But more importantly, it is also not clear when to approach which therapeutic strategy. Methods Patients who were diagnosed with Ogilvie’s syndrome at our institution in a 17-year time period (2002–2019) were included and retrospectively evaluated regarding different therapeutical strategies: conservative, endoscopic, or surgical. Results The study included 71 patients with 21 patients undergoing conservative therapy, 25 patients undergoing endoscopic therapy, and 25 patients undergoing surgery. However, 38% of patients (n = 8) who were primarily addressed for conservative management failed and had to undergo endoscopy or even surgery. Similarly, 8 patients (32%) with primarily endoscopic treatment had to proceed for surgery. In logistic regression analysis, only a colon diameter ≥ 11 cm (p = 0.01) could predict a lack of therapeutic success by endoscopic treatment. Ninety-day mortality and overall survival were comparable between the groups. Conclusion As conservative and endoscopic management fail in about one-third of patients, a cutoff diameter ≥ 11 cm may be an adequate parameter to evaluate surgical therapy.

Ogilvie’s syndrome following cesarean delivery: a case report

Ogilvie’s syndrome (OS) or acute pseudo-obstruction of the large bowel, is a rare condition and the true incidence is unknown. We present a case of acute colonic pseudo-obstruction (OS) post cesarean section in a 35-year-old patient with fetal distress, following cesarean delivery at term under general anesthesia. On the second postoperative day, she complained of abdominal distension, pain, nausea, vomiting, bloating and no passage of stool. As the patient's condition did not improve, she continued to have persistent abdominal distention. A plain abdominal film was taken and abdominal ultrasound was done, which showed massive gaseous distention of the bowels without fluid level. At laparotomy, a huge distended gut, pussy flakes on intestine, and massive dilatation of the whole colon were found. Postoperatively, the patient was managed with fluids, antibiotics, nutritional support, etc., along with the standard guidelines for management of peritonitis. The patient recovered and was discharged after 1 day of intensive care unit management to the ward. The need for awareness about the syndrome and early diagnosis is emphasized.

Ogilvie's syndrome presented with delirium in an older lady with corticobasal syndrome

Objective Corticobasal syndrome (CBS) is one of an atypical parkinsonian syndromes characterized by extrapyramidal features as well as cortical involvement signs. A variety of factors may lead to delirium in older adults with chronic progressive life-limiting neurological illnesses like CBS. Ogilvie's syndrome (OS) is an acute colonic pseudo-obstruction in which abdominal distension, nausea, vomiting, and constipation can be seen. We report a case of OS identified as the underlying possible cause of delirium in an 80-year-old woman with CBS. We also discuss the importance of holistic approach which is essential to manage the underlying cause and to preserve the quality of life in particular for the frail geriatric population who potentially needs palliative care or already benefits from palliative care. Method An older patient with CBS presented with symptoms similar to that of acute colonic obstruction and subsequently developed delirium. The patient was found to have colonic pseudo-obstruction (OS). Result Neostigmin infusion was therefore given to treat it and delirium was resolved. Significance of results To the best of our knowledge, clinical manifestation of delirium as OS in a patient with CBS has not been previously reported. OS may be superimposed to CBS in older patients, and OS in such patients may play a role as a precipitating factor for the development of delirium. Given the fact that CBS is progressive and rare neurodegenerative disease and almost all of these patients need palliative care, eventually, health-care professionals, especially in palliative care, should be aware of distinctive challenges of life-limiting chronic neurological illnesses, such as conditions that may lead to the development of acute colonic pseudo-obstruction because the rapid treatment of them prevents the use of potentially harmful drugs, surgical procedures, or inappropriate interventions.