O'Gilvie's Syndrome (colonic pseudo-obstruction) in the intensive care unit

Background

O'Gilvie's syndrome (colonic pseudo-obstruction) is a gastrointestinal motility disorder affecting the whole bowel but involving mainly the colon. It produces an acute massive dilation of the large bowel without organic obstruction. The cause of the disease is not known but it seems to involve some autonomic neurologic disorder affecting the myenteric plexus. For unknown reasons it affects selectively elderly, COPD patients with critical diseases (sepsis, polytrauma, vascular disease, etc.). The mainstay of the differential diagnosis is to exclude any cause of mechanical ileus. The treatment of the syndrome is mainly supportive including administration of fluids and electrolytes, total parenteral nutrition, and cisapride. If after these measures pseudo-obstruction still persists, colonoscopic decompression is required. An endoscopic placement of a transanal large bore nasogastric tube in the transversus colon is suggested. Continuous lavage of the colon through the tube could be useful. If after these measures the colon is still dilated, surgery with cecostomy is indicated.

Results

In the next table we report our experience in six cases of O'Gilvie syndrome patients during the years 1996–1997.

Conclusion

In our experience O'Gilvie's syndrome is much more common than reported. Medical treatment including cisapride is valuable but in severe cases colonoscopic decompression with transanally NG tube placement with continous lavage is required. In some cases a surgical decompressive cecostomy may be necessary.

Table