A health condition in which an intestinal pseudo-obstruction that often feels like something is physically blocking the bowels is called Ogilvie syndrome. Moreover, this disorder is an acute form of colonic pseudo-obstruction. Usually, it occurs suddenly after an illness, injury, or surgery.
This syndrome is also known as acute colonic pseudo-obstruction (ACPO). It often causes an unexplained paralysis of the colon and acts as if it is blocked or obstructed by something. However, there is nothing physical that blocks it. It is believed that ACPO occurs due to a problem in the colon’s motor system that prevents the food from moving along. As a result, it leads to a buildup, causing intestinal walls to widen (dilate).
This condition occurs rarely, and it affects about 1 in 1,000 people in hospitals.
What is The Difference between Ogilvie Syndrome and Other Types of Intestinal Pseudo-obstruction?
Generally, Ogilvie syndrome is an acute disorder that means sudden and temporary problems with the colon (large intestine). However, “intestinal pseudo-obstruction” is a medical term that refers to any paralysis of the intestines that is not caused by a mechanical obstruction. Sometimes, people develop a chronic (long-lasting) form of intestinal pseudo-obstruction. It often occurs due to other chronic diseases or congenital (present at birth) disorders.
Symptoms
The symptoms usually appear when the food is partially digested and begins to build up in the colon. Check below for the most common symptoms of Ogilvie syndrome:
- Abdominal distension or pain
- Appetite changes
- Nausea
- Vomiting
- Bloating
- Gas
- Constipation
- Diarrhea
Do not hesitate to contact your doctor if any of the previous symptoms occur.
Causes
Currently, healthcare professionals do not fully understand why this condition happens. However, they think it occurs due to a dysfunction of the autonomic nervous system. It is a part of the nervous system that controls the involuntary muscle movements responsible for regulating the intestines (peristalsis). Furthermore, even some unusual stress on the autonomic nervous system can trigger this disorder. Check below some health conditions that can trigger Ogilvie syndrome:
- Myocardial infarction (heart attack)
- Congestive heart failure
- Traumatic injury
- Severe infections (including pneumonia and sepsis)
- Open heart or abdominal surgery
- Orthopedic surgery (such as hip replacement)
- C-section (cesarean delivery)
Risk Factors
While Ogilvie syndrome is not fully understood, physicians have found some factors that may contribute to its development. Check below some examples:
- Age – The average age of people affected by this syndrome is 60.
- Kidney failure
- Neurological or cardiovascular disease
- Cancer
- Metabolic disorders
- Electrolyte imbalances
- Physical debilitations
- Severe infections
In addition, there are some medicines that are often associated with Ogilvie syndrome. For example:
- Opioids (especially if they are used for long periods)
- Immunosuppressants
- Spinal anesthesia
- Amphetamines
- Corticosteroids
- Antipsychotic medicines
What Are The Potential Complications of Ogilvie Syndrome?
While most people get rid of this condition with supportive care, some people may need interventions to treat it. For instance, if you develop Ogilvie syndrome and do not know about it for long periods, it may worsen and cause serious complications. According to some studies, complications often occur when the large intestine is wider than 12 cm (normally, the diameter of the colon is 8 cm). Check below some health problems that significantly increase the risk of developing Ogilvie syndrome complications:
- Ischemia – An increased pressure against the large intestine walls may reduce blood flow, which may lead to severe inflammation (ischemic colitis). If it is left untreated, you may experience necrosis (tissue death).
- Perforation – Necrosis increases the risk of tearing. Thus, it may lead to a hole in the large intestine (also known as gastrointestinal perforation) that can cause toxins and bacteria to escape into the abdominal cavity. As a result, it may lead to peritonitis (a life-threatening infection).
- Sepsis – This is another serious infection that often occurs when peritonitis spreads to the bloodstream (septicemia). Moreover, it is a medical emergency that can cause multiple organ failures.
This document does not contain all possible conditions that can widen the colon. However, you can consult with your healthcare professional about ways to reduce the risk of developing them.
How to Prevent Ogilvie Syndrome?
Unfortunately, there is no way to prevent this condition because experts do not fully understand what exactly causes it. However, doctors may recommend some tips to prevent complications of this condition that can be fatal. For instance, the mortality rate for perforation or ischemia is about 40%. However, approximately 15% of people with Ogilvie will never develop the previous complications.
Diagnosis
Usually, it is quite difficult to diagnose this condition because it causes symptoms similar to other disorders. Generally, the diagnosis depends on radiology showing a dilated colon with no physical bowel obstruction, as well as specific tests that help rule out other possible causes.
Types of Radiology
Healthcare professionals often use a type of imaging that combines radiology with an internal contrast agent that helps examine the colon. These materials help make features stand out better in black and white. This substance can be given as a pill that you swallow or intravenously (IV). In most cases, they use contrast CT (computed tomography) scans and contrast fluoroscopy.
Another test used by doctors is known as a gastrografin enema. It involves an injection with a water-soluble contrast solution (Gastrografin) directly into the large intestine through the rectum. Therefore, doctors will take a fluoroscopic X-ray to examine the colon. Sometimes, this injection may cause an adverse reaction, such as diarrhea, because it works similarly to a laxative.
Treatment
In most cases, healthcare professionals recommend different treatment options for people with Ogilvie syndrome because they depend on several factors. These include the severity and size of the colon, the risk of complications, age, and preferences. Check below some conservative options:
- Treatments for the underlying disorders
- Stopping the use of medicines that contribute to Ogilvie syndrome
- Bowel rest, with no food by mouth to reduce compression
- IV (intravenous) fluids that help correct electrolyte imbalances and keep you hydrated
- Walking or moving into different positions to help bowel movement
- Rectal tube (this is a catheter inserted into the rectum to drain air and fluid by gravity)
- Nasogastric tube (it helps evacuate excess air and fluid from the stomach)
- Regular monitoring
If your large intestine is already widened and the previous options do not help, doctors may recommend other procedures to treat it. Check below some examples:
- Colonoscopic decompression – This is a specific procedure that involves a colonoscope (a long and flexible tube with a lighted camera on the end) that is inserted into the large intestine through the anus. The goal of this treatment is to suction excess air from the large intestine. Usually, it helps relieve the symptoms caused by Ogilvie syndrome.
- Neostigmine injection – This is an intravenous (IV) medicine used to activate the muscles. Therefore, the muscles wake up after a dose of anesthesia that relaxed them. In most cases, this medicine works effectively and reactivates peristalsis in people with this syndrome. It is important to get this medicine under medical supervision because it is a powerful drug.
- Colectomy (colostomy) – This treatment is often recommended when other options do not help, or you develop a perforation or necrosis. During this procedure, surgeons will remove the affected part of the colon.
Frequently Asked Questions
What is the difference between Ogilvie syndrome and paralytic ileus?
While both conditions are types of intestinal pseudo-obstruction, paralytic ileus negatively affects both the intestines (including small and large bowels). However, Ogilvie syndrome affects the large intestine only. Mostly, people develop paralytic ileus after an abdominal surgery, but it disappears within several days without treatment.
What causes Ogilvie syndrome?
While experts do not know the exact cause of this syndrome, they believe it occurs due to an underlying condition, trauma, or surgery that negatively affects the nerves and muscles that control the large intestine. The most common triggers include recent surgical interventions, severe infections, heart disease, trauma, and certain medications (such as opioids or corticosteroids).
What is the life expectancy of Ogilvie syndrome?
While the mortality rate is about 40% in people with perforation or ischemia, approximately 15% of people with Ogilvie syndrome do not develop complications. If you have this syndrome without complications, the mortality rate is about 15%. Ask your healthcare provider if you have any other questions.
