Ogilvie syndrome medical therapy: Difference between revisions
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*** Although decompression of the obstruction using the colonoscopy is difficult, it has shown high success rates in some studies. | *** Although decompression of the obstruction using the colonoscopy is difficult, it has shown high success rates in some studies. | ||
*** Colonoscopic decompression must be performed carefully due to risk of perforation. Moreover, no administration of oral substances or enemas before the colonoscopy procedure to prevent the risk of aspiration. | *** Colonoscopic decompression must be performed carefully due to risk of perforation. Moreover, no administration of oral substances or enemas before the colonoscopy procedure to prevent the risk of aspiration. | ||
** Percutaneous | ** Percutaneous cecostomy:<ref name="pmid2343112">{{cite journal| author=vanSonnenberg E, Varney RR, Casola G, Macaulay S, Wittich GR, Polansky AM et al.| title=Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience. | journal=Radiology | year= 1990 | volume= 175 | issue= 3 | pages= 679-82 | pmid=2343112 | doi=10.1148/radiology.175.3.2343112 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2343112 }}</ref> | ||
*** | *** Using the endoscope and radiologic guidance, percutaneous cecostomy can be performed to relieve cases with acute colonic pseudo-obstruction. | ||
*** As it is an invasive procedure, it carries risk of bleeding and infections. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Revision as of 18:56, 6 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
Medical Therapy
Supportive care
- Supportive care is recommended in patients with colonic pseduo-obstruction in order to prevent the development of serious complications like intestinal perforation. It can be performed in the first few days after diagnosing the colonic pseudo-obstruction as long as there is no severe pain or extreme abdominal distension.[1]
- The supportive measures include the following:[2]
- Following up and management any underlying cause like heart failure or infection
- Terminating any concurrent medication that may cause intestinal dysmotility like opoids and calcium channel blockers
- Administration of intravenous saline and fluids in order to preserve the normal body homeostasis
- Placement of the patients in a prone position with elevation of the hips
Medical therapy
Neostigmine
- The first management approach of Ogilvie's syndrome is the supportive care. If the pseudo-obstruction remains refractory, neostigmine is recommended.
- Neostigmine is an antidote, cholinergic cholinesterase inhibitor and autonomic central nervous system agent that is FDA approved for the treatment of the reversal of the effects of non-depolarizing neuromuscular blocking agents after surgery.[3]
- Common adverse reactions include hypotension, nausea, bradycardia, and vomiting. Hereby, atropine should be administrated when need for adverse effects reversal.[4]
- Preferred regimen: 2mg slow IV infusion for interval of 3 to 5 minutes.
Decompression techniques
- A last management approach (before the surgical option) for the colonic pseudo-obstruction is the non surgical decompression of the obstruction.
- Non surgical decompression can be performed through the following:
- Colonoscopic decompression:[5][6]
- Although decompression of the obstruction using the colonoscopy is difficult, it has shown high success rates in some studies.
- Colonoscopic decompression must be performed carefully due to risk of perforation. Moreover, no administration of oral substances or enemas before the colonoscopy procedure to prevent the risk of aspiration.
- Percutaneous cecostomy:[7]
- Using the endoscope and radiologic guidance, percutaneous cecostomy can be performed to relieve cases with acute colonic pseudo-obstruction.
- As it is an invasive procedure, it carries risk of bleeding and infections.
- Colonoscopic decompression:[5][6]
References
- ↑ Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF; et al. (2002). "Acute colonic pseudo-obstruction". Gastrointest Endosc. 56 (6): 789–92. PMID 12447286.
- ↑ Sloyer AF, Panella VS, Demas BE, Shike M, Lightdale CJ, Winawer SJ; et al. (1988). "Ogilvie's syndrome. Successful management without colonoscopy". Dig Dis Sci. 33 (11): 1391–6. PMID 3180976.
- ↑ Rausch ME, Troiano NH, Rosen T (2007). "Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy". J Perinatol. 27 (4): 244–6. doi:10.1038/sj.jp.7211669. PMID 17377607.
- ↑ Saunders MD, Kimmey MB (2005). "Systematic review: acute colonic pseudo-obstruction". Aliment Pharmacol Ther. 22 (10): 917–25. doi:10.1111/j.1365-2036.2005.02668.x. PMID 16268965.
- ↑ Jetmore AB, Timmcke AE, Gathright JB, Hicks TC, Ray JE, Baker JW (1992). "Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors". Dis Colon Rectum. 35 (12): 1135–42. PMID 1473414.
- ↑ Geller A, Petersen BT, Gostout CJ (1996). "Endoscopic decompression for acute colonic pseudo-obstruction". Gastrointest Endosc. 44 (2): 144–50. PMID 8858319.
- ↑ vanSonnenberg E, Varney RR, Casola G, Macaulay S, Wittich GR, Polansky AM; et al. (1990). "Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience". Radiology. 175 (3): 679–82. doi:10.1148/radiology.175.3.2343112. PMID 2343112.