Ogilvie syndrome medical therapy
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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
Supportive care is the first line of management of the colonic pseudo-obstruction. The supportive measures include treatment of the underlying cause of the obstruction, terminating the concurrent medications that may cause intestinal dysmotility, and administration of intravenous fluids and saline. Neostigmine can be used in the cases of pseudo-obstruction resistant to the supportive measures. Non-surgical techniques can be performed to decompress the obstructionand it includes colonoscopic decompression and percutaneous cecostomy.
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 opioids 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 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.