![]() If the syndrome is suspected, expect the physician to order a nasogastric (NG) tube attached to suction. ![]() ![]() Initially, Ogilvie’s syndrome calls for conservative treatment. Also, enemas increase colonic pressure, heightening the risk of colonic ischemia and perforation.) (Note: Barium enemas should not be used in patients with suspected Ogilvie’s syndrome because barium retention may occur or barium may leak into the peritoneal cavity if the colon is perforated. Water-soluble contrast enemas help rule out mechanical obstruction. Computed tomography scans with contrast may reveal mechanical obstruction or bowel perforation. Several types of contrast studies may be useful. Cecal diameters greater than 12 cm (4.7″) are clinically significant in some studies of Ogilvie’s patients, diameters were as large as 25 cm (9.8″) and massive dilation occurred along the entire length of the colon-not just the right side. Typically, plain X-rays show massive dilation of the colon, especially pronounced in the ascending and transverse segments. Classically, Ogilvie’s syndrome causes the most significant dilation on the right side of the colon proximal to the splenic flexure, so you may hear more tympanic sounds over the right quadrant than over the left.Ībdominal X-rays are crucial to diagnosis. However, large amounts of gas trapped in the colon commonly produce tympanic sounds (hollow, drumlike reverberations) on abdominal percussion. Other differential diagnoses include simple constipation, volvulus, paralytic ileus, and ischemic colon.īecause Ogilvie’s syndrome may cause hyperactive, hypoactive, normal, or absent bowel sounds, assessment of bowel sounds may lack diagnostic value. Many patients also report lack of bowel movements or flatus-yet about 40% of patients with confirmed Ogilvie’s syndrome continue to pass stools.ĭiagnosis hinges on ruling out other potential causes of signs and symptoms-especially mechanical large-bowel obstruction. However, unless bowel ischemia or perforation has occurred, severe pain and fever aren’t classic signs of Ogilvie’s. Some patients complain of a full or swollen belly plus mild abdominal pain. abdominal pain, distention, and tenderness severe distention may occur over 24 hours to 3 days.Risk factors for Ogilvie’s syndrome include a wide range of conditions and use of certain drugs.Ĭommon signs and symptoms of Ogilvie’s syndrome include: ![]() Other theories about the cause of Ogilvie’s syndrome include multisystem organ failure, cecal volvulus, and immobility. These consequences increase the risk of bowel perforation, which has a mortality exceeding 50%. Unopposed, excessive SNS stimulation causes colonic inactivity, which in turn leads to fluid and gas build-up and massive dilation. Some researchers believe that in Ogilvie’s syndrome, the PNS is suppressed, leaving the SNS overstimulated. Generally, the SNS and PNS work in harmony to maintain adequate GI function. Normally, stimulation of the parasympathetic nervous system (PNS, the other branch of the autonomic nervous system) decreases the heart rate and blood pressure while increasing GI motility and colonic contraction and relaxing the anal sphincter. One of the two branches of the autonomic nervous system, the SNS boosts blood flow to the heart, brain, and other vital organs increases the heart rate and blood pressure reduces GI motility and inhibits colonic activity. The leading theory holds that lack of GI motility results from overstimulation of the sympathetic nervous system (SNS). The cause of Ogilvie’s syndrome isn’t known. Ogilvie’s syndrome is a massive dilation of the colon in the absence of mechanical obstruction, as from an adhesion or a tumor. Unless properly assessed and diagnosed, this condition may lead to large-bowel rupture, which can be fatal. In most cases, these signs and symptoms subside with use of a regimen such as prune juice, warm fluids, stool softeners, oral laxatives, suppositories, enemas, and mobilization.īut in rare cases, they represent a potentially serious condition-acute colonic pseudo-obstruction, or Ogilvie’s syndrome. Nearly every day, nurses hear patients complain of bloating, fullness, abdominal tenderness, and constipation.
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