Ogilvie's Syndrome Information - symptom, cause, picture, treatment of
Ogilvie's Syndrome Information
Spontaneous massive dilation of the cecum and proximal colon may occur in a number of different settings in hospitalized patients. Progressive cecal dilation may lead to spontaneous perforation with dire consequences. The risk of perforation correlates poorly with absolute cecal size. Colonic pseudo-obstruction is most commonly detected in surgical patients after trauma or burns or in the postoperative period and in medical patients with respiratory failure, metabolic imbalance, malignancy, myocardial infarction, congestive heart failure, pancreatitis, or a recent neurologic event (stroke, subarachnoid hemorrhage, trauma). Liberal use of narcotics or anticholinergic agents may precipitate colonic pseudo-obstruction in susceptible patients. It may also occur as a manifestation of colonic ischemia. The etiology of colonic pseudo-obstruction is unknown, but an imbalance between gut sympathetic activity and sacral parasympathetic innervation of the distal colon is hypothesized.
Symptoms of bacterial overgrowth
Many patients are on ventilatory support or are unable to report symptoms due to altered mental status. Abdominal distention is frequently noted by the clinician as the first sign, often leading to a plain film radiograph that demonstrates colonic dilation. Some patients are asymptomatic, though most report constant but mild abdominal pain. Nausea and vomiting may be present. Bowel movements usually are absent. Abdominal tenderness with some degree of guarding or rebound tenderness may be detected; however, signs of peritonitis are absent unless perforation has occurred. Bowel sounds may be normal or decreased.
Treatment of bacterial overgrowth
Conservative treatment is the appropriate first step for patients with no or minimal abdominal tenderness, no fever, no leukocytosis, and a cecal diameter less than 12 cm. The underlying illness is treated appropriately. A nasogastric tube and a rectal tube should be placed. Patients should not remain in one position but should be periodically rolled from side to side and to the prone position in an effort to promote expulsion of colonic gas. All drugs that reduce intestinal motility, such as narcotics, anticholinergics, and calcium channel blockers, are discontinued if possible. Enemas may be administered judiciously if large amounts of stool are evident on radiography. Oral laxatives are not helpful and may cause perforation, pain, or electrolyte abnormalities.