colonic pseudo-obstruction

Colonic pseudo-obstruction, also known as Ogilvie syndrome, is a potentially fatal condition that leads to an acute colonic distention without an underlying mechanical obstruction [11]. It is defined as an acute pseudo-obstruction and dilatation of the colon in the absence of any physical blockage [12].

This condition is characterized by colonic dysmotility, which means that the muscles in the colon are not functioning properly, resulting in colonic distension [13]. The symptoms of colonic pseudo-obstruction can vary from person to person but may include abdominal pain, bloating, nausea and vomiting, constipation, diarrhea, and a feeling of being too full after eating a meal [14].

In terms of diagnostic imaging, plain film radiographs often demonstrate colonic dilation, usually confined to the cecum and proximal colon. Varying amounts of small intestinal dilation and air-fluid levels may also be present. A CT scan can be used to exclude distal colonic obstruction if suspected.

It's worth noting that colonic pseudo-obstruction is associated with considerable morbidity and mortality, although the underlying pathophysiology remains poorly understood [13]. An abundance of risk factors and associated conditions have been identified, suggesting a multifactorial origin for this condition.

Common Signs and Symptoms of Colonic Pseudo-Obstruction

Colonic pseudo-obstruction, also known as Ogilvie syndrome, is a condition that mimics the symptoms of a mechanical bowel obstruction but without any physical blockage. The signs and symptoms can vary from person to person, but here are some common ones:

• Abdominal distention (bloating): A feeling of fullness or swelling in the abdomen, which can be uncomfortable and painful [9].
• Nausea and vomiting: Many people experience nausea and vomiting due to the buildup of gas and fluid in the intestines [7][8].
• Constipation: The inability to pass stool or gas, which can lead to a feeling of being constipated [1][6].
• Abdominal pain: Pain in the abdomen, which can range from mild to severe [5][11].
• Diarrhea: Some people may experience diarrhea, especially if they have an underlying condition that affects their gut motility [9].
• Early satiety (feeling full quickly): A feeling of being full after eating a small amount of food [8].

Other Possible Symptoms

In addition to the above symptoms, some people may also experience:

• Food aversion: A loss of appetite or a strong dislike for certain foods due to the discomfort and pain associated with eating [9].
• Painful bowel movements: Painful or difficult bowel movements can occur in some cases [11].

Important Note

If you or someone you know is experiencing these symptoms, it's essential to seek medical attention immediately. Colonic pseudo-obstruction can be a sign of an underlying condition that requires prompt treatment.

References:

[1] Context result 3 [5] Context result 5 [6] Context result 8 [7] Context result 7 [8] Context result 8 [9] Context result 9 [11] Context result 11

Diagnostic Testing for Colonic Pseudo-Obstruction

Colonic pseudo-obstruction, also known as Ogilvie syndrome, is a condition where the colon becomes dilated and cannot pass gas or stool, despite no physical blockage. Diagnostic testing is essential to confirm the diagnosis and rule out other conditions.

• Routine Blood Tests: Patients with suspected colonic pseudo-obstruction should undergo routine blood tests, including:
  • Full blood count
  • Urea & electrolytes
  • Ca 2+ and Mg 2+
  • Thyroid function tests [1]
• Imaging Studies: Imaging studies can help confirm the diagnosis and rule out other conditions. These include:
  • CT scan of abdomen pelvis with intravenous contrast: This imaging study can show the dilated colon, without any obvious narrowing or transition point [4].
  • Small bowel (duodenal and/or jejunal) manometry: This is considered the gold-standard diagnostic test for intestinal motility disorders, including colonic pseudo-obstruction [3].

Confirming Diagnosis

The diagnosis of colonic pseudo-obstruction can be confirmed via imaging studies and blood tests. It's essential to rule out other conditions that may cause similar symptoms.

• Small Bowel Manometry: This test is especially helpful in cases where the inter-episodic radiology is normal [3].
• CT Scan: A CT scan of the abdomen pelvis with intravenous contrast can show the dilated colon, without any obvious narrowing or transition point [4].

References

[1] American Society for Gastrointestinal Endoscopy. (2022). Standards of Practice Committee.

[3] Figure 1: Small bowel manometry is the gold-standard diagnostic test for intestinal motility disorders.

[4] Investigations: Patients with a suspected pseudo-obstruction should have routine blood tests performed, including full blood count, urea & electrolytes, Ca 2+ and Mg 2+, and thyroid function tests.

Treatment Options for Colonic Pseudo-Obstruction

Colonic pseudo-obstruction, also known as Ogilvie syndrome, can be treated with various medications and interventions. The primary goal of treatment is to relieve symptoms, prevent complications, and restore normal bowel function.

• Neostigmine: This medication is often considered the first-line treatment for colonic pseudo-obstruction. Neostigmine works by increasing the movement of food through the intestines and has been shown to be effective in relieving symptoms in most patients [5][8]. Studies have demonstrated that neostigmine can lead to prompt colon decompression in the majority of patients with acute colonic pseudo-obstruction [8].
• Other Medications: In some cases, other medications such as metoclopramide or erythromycin may be used to stimulate bowel movement and relieve symptoms. However, their effectiveness is less well-established compared to neostigmine.
• Colonoscopy: This procedure involves inserting a flexible tube with a camera into the colon to remove air and help restore normal bowel function. Colonoscopy may be performed in conjunction with other treatments, such as medication or surgery.

Important Considerations

It's essential to note that treatment for colonic pseudo-obstruction should be individualized based on the patient's specific needs and underlying health conditions. In some cases, patients may require more aggressive treatment, including surgery, to prevent complications and restore normal bowel function.

References:

[5] Saunders MD. The only proven effective medical therapy currently available for pseudo-obstruction is neostigmine, a cholinesterase inhibitor. Neostigmine increases... [6]

[8] Saunders MD. The best-studied treatment of acute colonic pseudo-obstruction is intravenous neostigmine, which leads to prompt colon decompression in the majority of patients...

Differential Diagnosis of Colonic Pseudo-Obstruction

Colonic pseudo-obstruction, also known as Ogilvie syndrome, is a condition characterized by the dilation of the colon without any mechanical obstruction. The differential diagnosis for this condition includes several possible causes that can be considered to rule out other underlying conditions.

• Mechanical colonic obstruction: This includes conditions such as malignancy, diverticulitis, volvulus, fecal impaction, and sigmoid or cecal volvulus [8][9].
• Toxic megacolon: A complication of inflammatory bowel disease that can cause severe dilation of the colon [9].
• Chronic megacolon: A condition characterized by persistent dilation of the colon, often due to chronic constipation or fecal impaction [8].
• Fecal impaction: A condition where a hard mass of stool becomes impacted in the rectum, causing obstruction and dilation of the colon [8][9].
• Rectal prolapse: A condition where the rectum loses its normal attachment to the pelvic floor muscles, leading to protrusion of the rectum through the anus [8].
• Sigmoid or cecal volvulus: A rare condition where the sigmoid or cecum twists around itself, causing obstruction and dilation of the colon [8][9].

These conditions can be considered in the differential diagnosis for colonic pseudo-obstruction to rule out other underlying causes. It is essential to perform a thorough evaluation, including imaging studies and endoscopy, to determine the correct diagnosis.

References: [8] - Jan 24, 2020 — Differential Diagnoses · Chronic Megacolon · Fecal Impaction · Foreign Body · Malignancy · Rectal Prolapse · Sigmoid and Cecal Volvulus · Toxic ... [9] - Differential Diagnosis · Mechanical colonic obstruction, eg, malignancy, diverticulitis, volvulus, fecal impaction · Toxic megacolon due to inflammatory bowel ...