Year 2025 / Volume 117 / Number 3
Letter
Ogilvie, when medical and endoscopic treatment fail

169-170

DOI: 10.17235/reed.2024.10287/2024

Isabel González Puente, Ana Belén Domínguez Carbajo, Sandra Borrego Rivas, Raisa Quiñones Castro,

Abstract
Ogilvie syndrome is a functional disorder of colonic motility that causes acute and progressive dilation, which can lead to necrosis and perforation. Early diagnosis and management are essential to avoid serious complications. The case of a patient with Ogilvie syndrome refractory to medical and endoscopic treatment that required surgery is presented. This is a 68-year-old man with decreased level of consciousness and abdominal distension for 3 days. Last bowel movement 4 days ago. The data and tests appear in table 1. We are faced with a patient with neurological alteration and hemodynamically unstable secondary to complicated Ogilvie syndrome. After admission to the ICU, where a 2.5 mg bolus of neostigmine was administered, he was transferred to the ward. Despite 250 mg of intravenous erythromycin every 6 hours together with metoclopramide every 8 hours, high doses of polyethylene glycol and daily cleansing enemas and rectal catheterization, only a brief and mild improvement is achieved. Given the failure of conservative measures, colectomy was performed, achieving complete resolution. Ogilvie syndrome is a functional disorder1 that usually associates predisposing factors that impact intestinal motility 2 ; In our case: bedridden, the use of anticholinergics, hydroelectric alteration both due to the use of antidepressants and the creation of a third space secondary to colonic dilation and severe intestinal ischemia². In one third it is resolved by early correction of the triggering factors, adding neostigmine if necessary with high rates of effectiveness¹. In our case, a second bolus of neostigmine could have been administered or even as an infusion since greater efficacy has been demonstrated in this way given its short half-life². Electrolyte imbalance is a predictor of poor response to neostigmine, a factor that was associated with our patient 3. Colonic decompression and finally surgery are reserved as a last measure, being necessary in a very small percentage as in this case 1. As a preventive measure, the administration of 29.5 g of oral polyethylene glycol per day has been effective 4. Therefore, we should suspect Ogilvie syndrome in patients with predisposing factors who present acute dilation of the colon without mechanical obstruction, and although it usually resolves with medical and endoscopic treatment, we should not delay surgery to avoid complications.
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References
Palma Ramírez EJ, Pradel Mora JJ, López Montero M, et al. Síndrome de Ogilvie. Reporte de caso y revisión de la literatura. Cirujano general. 2014 [cited 2024 Jan 6];36(4):232–8
Núñez-García E, Valencia-García LC, Sordo-Mejía R, el al. Drug related colonic perforation: Case report]. Cirugia y Cirujanos. 2016 Jan 1 [cited 2021 Jun 15];84(1):65–8.
Wells CI, O’Grady G, Bissett IP. Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms. World Journal of Gastroenterology. 2017 Aug 14;23(30):5634– 44.
Sgouros SN. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut. 2006 May 1;55(5):638–42.
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González Puente I, Domínguez Carbajo A, Borrego Rivas S, Quiñones Castro R. Ogilvie, when medical and endoscopic treatment fail . 10287/2024


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Publication history

Received: 19/01/2024

Accepted: 25/01/2024

Online First: 02/02/2024

Published: 06/03/2025

Article Online First time: 14 days

Article editing time: 412 days


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