Síndrome de Ogilvie: manejo actual a propósito de un caso

Objetivo: Dar a conocer las últimas recomendaciones para la sospecha, el diagnóstico y el tratamiento médico y quirúrgico del síndrome de Ogilvie. Material y método: Estudio descriptivo, retrospectivo, observacional; en formato de caso clínico y revisión de la literatura actual, a través de PubMed, Scielo y otros motores de búsqueda de artículos científicos. Discusión y Conclusiones: La seudoobstrucción colónica aguda o síndrome de Ogilvie consiste en un íleo adinámico severo y dilatación masiva de asas del colon en ausencia de obstrucción mecánica. Se presenta, principalmente, en pacientes postquirúrgicos o severamente enfermos. Tienen riesgo de perforación aproximado del 3% y una mortalidad del 50%, la mayoría de los pacientes responden al manejo médico conservador. La descompresión colonoscópica puede ser necesaria en pacientes que no responden al tratamiento médico de soporte y a la descompresión farmacológica con neostigmina. Distintos grados de isquemia y/o perforación colónica obligan la reso-lución quirúrgica urgente en algunos casos, lo que define la morbimortalidad. Es importante la sospecha clínica de este síndrome para evitar complicaciones posiblemente fatales.

Objective: To present the latest recommendations for the suspicion, diagnosis and medical and surgical treatment of Ogilvie syndrome. Materials and methods: Descriptive, retrospective, observational study; in clinical case format and review of the current literature, through PubMed, Scielo and other search engines for scientific articles Discussion and Conclusions: Acute colonic pseudo-obstruction or Ogilvie syndrome consists of a severe adynamic ileus and massive dilatation of the colonic loops in the absence of mechanical obstruction. It occurs in post-surgical or severely ill patients. They have a risk of perforation of approximately 3% and a mortality of 50%, most patients respond to conservative medical management. Colonoscopic decompression may be necessary in patients who do not respond to supportive medical treatment and drug decompression with neostigmine. Different degrees of colonic ischemia and / or perforation require urgent surgical resolution in some cases, which defines morbidity and mortality. Clinical suspicion of this syndrome is important to avoid possibly fatal complications.

Utility of orcein stain and comparison with Masson trichrome stain in chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIPO) is caused by a plethora of primary and secondary causes, dominantly involving the neuromuscular tissue, interstitial cells of Cajal, or the connective tissue framework. The lack of the connective tissue framework, known as desmosis, is evaluated by Masson's trichrome (MT) or picrosirius red stains, both of which are recommended in the London classification. We evaluated the orcein stain in detecting desmosis in comparison to the MT stain. We performed both orcein and MT stains in six previously published cases of complete or partial desmosis along with six age-matched controls. Our results showed comparable results of the orcein stain as compared to the MT stain. Additional advantages of lower cost and a clearer background in orcein stain were noteworthy, whereas MT stain can be used for the detection of additional pathology. We believe that orcein stain can be used as a cheap alternative in resource-limited settings.

Pseudo-obstruction, an infrequent Lupus manifestation: A case report

Gastrointestinal involvement in SLE has been reported in up to 50%, generally secondary to the adverse effects of treatment. Intestinal pseudo-obstruction is caused by hypomotility related to ineffective propulsion. The case of a 51-year-old patient with intestinal obstruction is presented. She was taken to surgical management due to suspicion of adhesions, with a stationary clinical course; the control tomography documented loop dilation and bilateral hydroureteronephrosis, associated with markers of lupus activity. It was managed as an intestinal pseudo-obstruction due to SLE with resolution of her symptoms. High diagnostic suspicion results in timely treatment and the reduction of complications.

El compromiso gastrointestinal en lupus eritematoso sistémico (LES) ha sido reportado hasta en un 50%, generalmente secundario a los efectos adversos del tratamiento. La pseudoobstrucción intestinal es causada por hipomotilidad relacionada con una propulsión inefectiva. Se presenta el caso de una paciente de 51 arios, con obstrucción intestinal por sospecha de bridas, que fue llevada a manejo quirúrgico y tuvo una evolución clínica estacionaria. La tomografía de control documentó dilatación de asas e hidroureteronefrosis bilateral, en tanto que los paraclínicos mostraron actividad lúpica. Se manejó como una pseudoobstrucción intestinal por LES con resolución del cuadro. La alta sospecha diagnóstica favorece el tratamiento oportuno y la disminución de las complicaciones.

Advances in the genetics of pediatric chronic intestinal pseudo-obstruction / 国际儿科学杂志

Chronic intestinal pseudo-obstruction is a serious intestinal dysmotility disorder with symptoms of bowel obstruction without mechanical obstruction.Compared with chronic intestinal pseudo-obstruction in adults, pediatric chronic intestinal pseudo-obstruction has unique clinical characteristics.Generally, 80% of pediatric chronic intestinal pseudo-obstruction cases are primary and idiopathic and there is no specific treatment, and management is mainly symptomatic.With the advancements in genetic testing, new findings have been identified, allowing for a better understanding of the underlying mechanisms of intestinal dysmotility and potential etiologies.This article reviews the genetic research progress of pediatric chronic intestinal pseudo-obstruction in recent years, introduces the pathological mechanism and clinical characteristics, and summarizes the pearls of diagnosis and treatment.

Síndrome inflamatorio multisistémico asociado a COVID-19: a propósito de un caso clínico con fenotipo shock e íleo paralítico / Multisystem inflammatory syndrome associated with COVID-19: clinical case with shock phenotype and paralytic ileus / Síndrome inflamatória multissistêmica associada à COVID-19: relato de caso com fenótipo de choque e íleo paralítico

La enfermedad por coronavirus 2019 (COVID-19) causada por la infección por SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) se ha extendido por todo el mundo desde diciembre de 2019. Luego de la primera ola de COVID-19, se reporta por primera vez en mayo de 2020 en el Reino Unido un estado hiperinflamatorio asociado temporalmente a la infección por SARS-CoV-2 en un grupo de niños ingresados a unidades de cuidado intensivo pediátrico. Este nuevo fenotipo, con características similares a la enfermedad de Kawasaki y al síndrome del shock tóxico, se ha denominado síndrome inflamatorio multisistémico en niños (MIS-C). Es fundamental la sospecha y el reconocimiento tempranos de esta entidad, con el fin de ofrecer un tratamiento médico oportuno, para prevenir la muerte y el desarrollo de secuelas. Presentamos el caso de una preescolar de 5 años, en la que se realizó diagnóstico de MIS-C con un fenotipo shock e íleo paralítico.

The coronavirus disease 2019 (COVID-19) caused by the infection by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has spread worldwide since December 2019. After the first wave of COVID-19, a hyperinflammatory condition temporarily associated with SARS-CoV-2 infection appeared in a group of children admitted to pediatric intensive care units and reported for the first time in May 2020 in the United Kingdom. This new phenotype shared characteristics with the Kawasaki disease and toxic shock syndrome and has been called multisystem inflammatory syndrome in children (MIS-C). Early suspicion and recognition of this condition is key in order to offer timely medical treatment to prevent death and the development of sequelae. We present the case of a 5-year-old child, in which diagnosis of MIS-C with a shock phenotype and paralytic ileus.

A doença de coronavírus 2019 (COVID-19) causada pela infecção por SARS-CoV-2 (síndrome respiratória aguda grave coronavírus 2) se espalhou pelo mundo desde dezembro de 2019. Após a primeira onda de COVID-19, houve relatos pela primeira vez em maio de 2020 no Reino Unido duma doença hiperinflamatória temporariamente associada à infecção por SARS-CoV-2 num grupo de crianças internadas em unidades de terapia intensiva pediátrica. Esse novo fenótipo com características semelhantes à doença de Kawasaki e a síndrome do choque tóxico foi chamado de síndrome inflamatória multissistêmica em crianças (MIS-C). A suspeita precoce e o reconhecimento dessa entidade são essenciais, a fim de oferecer tratamento médico oportuno, para prevenir a morte e o desenvolvimento de sequelas. Apresentamos o caso de uma menina pré-escolar de 5 anos que foi diagnosticada com MIS-C com fenótipo de choque e íleo paralítico.

Isolated intestinal neuronal dysplasia- type B of ileum: A rare occurrence

Intestinal neuronal dysplasia type B in the gastrointestinal tract is a rare occurrence and may occur alone or in combination with Hirschsprung disease. Distal colon seems to be a frequent site for isolated IND-B cases; however, small bowel involvement is scarcely reported. We report a case of 9 years old boy presenting with features of intestinal pseudo-obstruction for 5 years. Exploratory laparotomy revealed narrowed distal ileum with huge proximal dilatation. Histopathology of the resected terminal ileum revealed giant submucosal ganglion, hyperplastic submucosal nerves, and ectopic ganglion cells in the lamina propria suggestive of IND-B. Although IND-B involving ileum in isolation is a rare occurrence, suspicion should be kept in cases of intestinal obstruction with minimal response to conventional treatment.

Fecal microbiota transplantation in the treatment of acute intestinal pseudo obstruction secondary to intracerebral hemorrhage: a case report and literature review / 中华危重病急救医学

Objective:To analyze the clinical effects of fecal microbiota transplantation (FMT) on the treatment of acute intestinal pseudo obstruction (AIPO) secondary to intracerebral hemorrhage.Methods:The clinical data of a patient with AIPO secondary to intracerebral hemorrhage who was admitted to Nanfang Hospital of Southern Medical University was analyzed. The flora compositon between donor and patient was compared, finding the changes of intestinal flora before and after FMT (day 0 and day 25).Results:The main clinical findings in the patient were serious bloating, expansion of the intestinal canal and intra-abdominal hypertension. A week of conventional therapy was not effective, and the symptoms became progressively worse, affecting respiratory function.The result of fecal flora suggested the intestinal microbiota dybiosis, so FMT was attempted. After FMT, the patient's gastrointestinal symptoms were significantly relieved, and there were no further episodes within 25 days. The new result of fecal flora showed that the flora colonizing the intestine was dominated by Akkermansia and Bifidobacterium, with a significant decrease in potential pro-inflammatory and gas-producing bacteria and an increased gut microbiota diversity. The results trended to be partly consistent with the donor at 25 days after FMT: at the phylum level, the relative abundance of Bacterioidetes, Vereucomicrobia, Firmicutes and Actinobacteria were increased while Proteobacteria was decreased; at the class level, the relative abundance of Verrucomicrobiae, Bacterioidia, Actinobacteria, Coriobacteriia and Clostridia were increased and Gammaproteobacteria was decreased; at the order level, the relative abundance of Bacterioidales, Verrucomicrobiales, Clostridiale, Coriobacteriales were increased and Betaproteobacteriales, Enterobacteriales were decreased; at the family level, the relative abundance of Bifidobacteriaceae, Akkermansiaceae, Ruminococcaceae were increased and Enterobacteriaceae was decreased; at the genus level, the relative abundance of Akkermansia, Bifidobacterium were increased and Escherichia-Shigella, Klebsiella were decreased. At 1-year follow-up, the patient lived with self-care and scored 5 points in Glasgow outcome scale (GOS). Conclusions:FMT may provide clinical benefit in treated patients with AIPO secondary to intracerebral hemorrhage, probably by regulating the intestinal microflora, and re-establishing proper intestinal barrier, to maintain intestinal homeostasis.

Systemic sclerosis and gastrointestinal involvement / Esclerosis sistémica y participación gastrointestinal

ABSTRACT Systemic sclerosis (SSc) is a systemic autoimmune disease in which gastrointestinal manifestations are a frequent complication. Gastrointestinal involvement is present in up to 90 % of patients. The most affected areas are the esophagus and the anorectal tract. Reflux, heartburn and dysmotility are the leading causes of gastrointestinal discomfort. Disordered anorectal function can occur early in the course of SSc and is an important factor in the development of fecal incontinence. Current recommendations to treat gastrointestinal disorders in SSc include the use of proton pump inhibitors, prokinetics and rotating antibiotics. This review discusses the proposed pathophysiological mechanisms, the clinical presentation, the different diagnostic techniques and the current management of the involvement of each section of the gastrointestinal tract in SSc.

RESUMEN La esclerosis sistémica (ES) es una enfermedad autoinmune sistémica en la que las manifestaciones gastrointestinales son una complicación frecuente. El compromiso gastrointestinal está presente hasta en 90% de los pacientes. Las áreas más afectadas son el esófago y el tracto anorrectal. El reflujo, la pirosis y la dismotilidad son las principales causas de malestar gastrointestinal. La función anorrectal alterada puede presentarse temprano en el curso de la ES y es un factor importante en el desarrollo de incontinencia fecal. Las recomendaciones actuales para tratar los trastornos gastrointestinales en la ES incluyen el uso de inhibidores de la bomba de protones, procinéticos y de antibióticos en forma rotativa. Esta revisión discute los mecanismos fisiopatológicos propuestos, la presentación clínica, las diferentes técnicas de diagnóstico y el manejo actual del compromiso de cada sección del tracto gastrointestinal en la ES.

Síndrome de Ogilvie asociado a hospitalización prolongada en un paciente con evento vascular cerebral isquémico. Reporte de un caso / Ogilvie Syndrome Associated with Prolonged Hospitalization in a Patient with an Ischemic Cerebrovascular Event. Case Report

Resumen Introducción: El síndrome de Ogilvie o seudoobstrucción colónica aguda es la dilatación aguda del colon, sin evidencia de obstrucción mecánica, y se atribuye a un desbalance autonómico de la inervación motora del colon. Es común en pacientes hospitalizados con comorbilidades importantes. Su manejo es escalonado, reservando el manejo quirúrgico para los casos refractarios al manejo médico inicial o con presencia de complicaciones como perforación y datos de sepsis. Caso clínico: Presentamos el caso de un paciente del sexo masculino, de 69 años de edad, quien acudió al servicio de urgencias en el contexto de evento vascular cerebral, quien cursó con intubación prolongada, iniciado a los 17 días de su ingreso, con distensión abdominal refractaria a manejo médico, con dilatación colónica importante, corroborada por tomografía de abdomen, por lo que se decidió manejo quirúrgico. Conclusiones: Es importante hacer diagnóstico precoz de este síndrome para evitar complicaciones propias de la enfermedad, así como de la cirugía. Importante hacer diagnóstico con otras causas de oclusión y tener un alto índice de sospecha al tratarse de un diagnóstico de exclusión.

Abstract Introduction: Ogilvie's syndrome or acute colonic pseudo-obstruction is the acute dilation of the colon without evidence of mechanical obstruction and is attributed to an autonomic imbalance of motor innervation of the colon. It is common in hospitalized patients with significant comorbidities. Its management is staggered, reserving surgical management for cases refractory to initial medical management or with the presence of complications such as perforation and sepsis data. Case report: We present the case of a 69-year-old male patient who went to the emergency service in the context of a cerebral vascular event. He underwent prolonged intubation, which began 17 days after his admission with abdominal distention refractory to medical management, with significant colonic dilation corroborated by abdominal tomography, so it was decided to manage it surgically. Conclusions: It is important to make an early diagnosis of this syndrome to avoid complications of the disease, as well as surgery. It is important to make a differential diagnosis with other causes of occlusion and have a high index of suspicion since it is a diagnosis of exclusion.

Chronic intestinal pseudo-obstruction in newborn: a case report

Chronic intestinal pseudo-obstruction (CIPO) is a rare and serious disorder of the gastrointestinal tract motility with the primary defect of impaired peristalsis. Symptoms are consistent with a bowel obstruction, although mechanical obstruction cannot be identified. It is a rare differential diagnosis for neonatal intestinal obstruction. Herein we report a case of neonate with non-resolving intestinal pseudo-obstruction, presenting since birth as progressive abdominal distention. The diagnosis was made by exclusion of mechanical causes of intestinal obstruction via thorough imaging studies.

Current Status in Management of Chronic Idiopathic Intestinal Pseudo-obstruction / 胃肠病学

Chronic intestinal pseudo-obstruction (CIPO) is a rare and serious motility disorder in gastrointestinal tract, which mimics mechanical intestinal obstruction clinically. It may be primary (idiopathic CIPO) or secondary to a organic, systemic or metabolic disorder. The etiology and mechanism of idiopathic CIPO are not yet clear. It might be linked to neuromuscular disorders of the digestive tract. Although there are a variety of diagnostic approaches, no standard diagnostic criterion has been achieved. Improper and delayed treatment may cause the increase in mortality. In this review article, the current status in management of idiopathic CIPO was summarized.

Evaluation of Recent Surgical Updates Regarding Diagnosis and Management of Intestinal Obstruction

Background: Intestinal obstruction is a painful abdominal condition that is ultimately managed by surgical methods.Proximal intestinal obstructions usually present clinically with pain, while distal obstructions havepronounced vomiting and absolute constipation. The junior surgeon should take careful note of anamnesis, as theobstruction is mainly a clinical diagnosis. Objectives: We focus in this paper on intestinal obstruction, diagnosticapproach, and surgical interventions, and only relevant studies are discussed. Methodology: PubMed databasewas used for articles selection, and papers on intestinal obstruction and pseudo-obstruction were obtained andreviewed. Conclusion: In summary, certain factors increase the vulnerability of patients and developing intestinalobstruc-tion, most notably including adhesions, neoplasms, and abdominal herniation. Exploratory laparot-omyis indicated when patients do not improve within 48 hours of conservative therapy, or perforat-ed bowels are seenon radiography (as air-under-the-diaphragm). Colonoscopy is valuable in ruling out mechanical obstruction anddecompressing a distended bowel. Team effort is needed to avoid non-urgent operation, and to identify and treatcurrent dehydration and correct depleted electro-lytes, while also preventing systemic inflammation, ischemia,and sepsis

Mechanism and treatment progress of prolonged postoperative ileus / 国际外科学杂志

Prolonged postoperative ileus(PPOI), as a common surgical complication, has attracted more and more attention of domestic scholars in recent years. PPOI is often manifested as intolerance of oral feeding, nausea and vomiting, abdominal pain, abdominal distention, delayed exhaust and defecation, and prolonged hospital stay and increased medical expenditure. At present, the pathogenesis of PPOI has not been determined, but it is certain that the disease is mediated by a variety of mechanisms. In clinical work, PPOI still have no general diagnostic criteria, treatment methods and prevention strategies. The theory and practice of accelerated rehabilitation surgery may bring new ideas for the prevention and treatment of PPOI. This paper reviews the research status and prevention strategies of PPOI.

Acute colonic pseudo-obstruction after cesarean section: a retrospective analysis of 11 cases / 中华围产医学杂志

Objective To summary the risk factors,clinical characteristics and treatment of acute colonic pseudo-obstruction (ACPO) after cesarean section(CS).Methods The case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018.Another 55 patients without ACPO after CS,performed within two weeks' difference from the case group,were randomly selected as the control group.Clinical data of all subjects were analyzed retrospectively.Potential clinical risk factors were statistically analyzed.T test,Chi-square test and logistic regression analysis were used for statistical analysis.Results In the case group,the abdominal distension presented on 2 d (n=1),3 d (n=7),4 d (n=2) and 17 d (n=1) respectively after CS,and all cases experienced abdominal pain and nausea.Vomiting was reported in some cases.Plain abdominal X-ray images revealed pneumocolon with colon pouch.The maximum diameter of cecum was 6 to 12 cm.Air-liquid levels were observed in two patients.All patients underwent fasting,gastrointestinal decompression,intravenous fluid infusion,correction of electrolyte imbalance,hypertonic saline enema and prophylactic antibiotic treatment.The disease condition lasted two to six days in these patients.Conservative treatment was successful in eight patients and failed in the other three who later went for operations.The maximum cecal diameters in the three patients who underwent surgery were all ≥ 9 cm,among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction.In this case,the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases.One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment.One patient suffered a relapse after having been treated conservatively for five days,and then underwent surgeries of resection of ileocecum,distal closure of the colon ascendens plus terminal ileostomy due to intestinal perforation.Multivariate logistic regression analysis showed that higher postoperative leukocyte count (OR=1.38,95％CI:1.12-1.71,P=0.003) and postoperative body temperature ＞38 ℃ (OR=6.47,95％CI:1.06-39.61,P=0.044) were the risk factors for ACPO after CS.Conclusions Elevated leukocyte count and body temperature ＞38 ℃ were two high-risk factors for ACPO after CS.ACPO is characterized by acute onset,and the first choice is conservative management.Active surgical treatment would be required if conservative treatment fails,especially when the maximum diameter of the cecum is ≥ 9 cm,which may increase the incidence of intestinal necrosis or perforation.

Waardenburg Syndrome Type IV De Novo SOX10 Variant Causing Chronic Intestinal Pseudo-Obstruction / 대한소아소화기영양학회지

Waardenburg syndrome (WS) type IV is characterized by pigmentary abnormalities, deafness and Hirschsprung's disease. This syndrome can be triggered by dysregulation of the SOX10 gene, which belongs to the SOX (SRY-related high-mobility group-box) family of genes. We discuss the first known case of a SOX10 frameshift mutation variant defined as c.895delC causing WS type IV without Hirschsprung's disease. This female patient of unrelated Kuwaiti parents, who tested negative for cystic fibrosis and Hirschsprung's disease, was born with meconium ileus and malrotation and had multiple surgical complications likely due to chronic intestinal pseudo-obstruction. These complications included small intestinal necrosis requiring resection, development of a spontaneous fistula between the duodenum and jejunum after being left in discontinuity, and short gut syndrome. This case and previously reported cases demonstrate that SOX10 gene sequencing is a consideration in WS patients without aganglionosis but with intestinal dysfunction.

Pyridostigmine in Pediatric Intestinal Pseudo-obstruction: Case Report of a 2-year Old Girl and Literature Review

Pediatric chronic intestinal pseudo-obstruction is a rare disorder characterized by a severe impairment of gastrointestinal motility leading to intestinal obstruction symptoms in the absence of mechanical causes. The diagnosis is usually clinical and diagnostic work is usually aimed to rule out mechanical obstruction and to identify any underlying diseases. Treatment is challenging and requires a multidisciplinary effort. In this manuscript we describe the youngest child successfully treated with the orally administrable, long-acting, reversible anti-cholinesterase drug, pyridostigmine. Like other drugs belonging to cholinesterase inhibitors, pyridostigmine enhances gut motility by increasing acetylcholine availability in the enteric nervous system and neuro-muscular junctions. Based on the direct evidence from the reported case, we reviewed the current literature on the use of pyridostigmine in severe pediatric dysmotility focusing on intestinal pseudo-obstruction. The overall data emerged from the few published studies suggest that pyridostigmine is an effective and usually well tolerated therapeutic options for patients with intestinal pseudo-obstruction. More specifically, the main results obtained by pyridostigmine included marked reduction of abdominal distension, reduced need of parenteral nutrition, and improvement of oral feeding. The present case and review on pyridostigmine pave the way for eagerly awaited future randomized controlled studies testing the efficacy of cholinesterase inhibitors in pediatric severe gut dysmotility.

Mechanism and treatment progress of prolonged postoperative ileus / 国际外科学杂志

Prolonged postoperative ileus(PPOI),as a common surgical complication,has attracted more and more attention of domestic scholars in recent years.PPOI is often manifested as intolerance of oral feeding,nausea and vomiting,abdominal pain,abdominal distention,delayed exhaust and defecation,and prolonged hospital stay and increased medical expenditure.At present,the pathogenesis of PPOI has not been determined,but it is certain that the disease is mediated by a variety of mechanisms.In clinical work,PPOI still have no general diagnostic criteria,treatment methods and prevention strategies.The theory and practice of accelerated rehabilitation surgery may bring new ideas for the prevention and treatment of PPOI.This paper reviews the research status and prevention strategies of PPOI.

Diagnosis and treatment of chronic intestinal pseudo-obstruction / 中国实用外科杂志

Chronic intestinal pseudo-obstruction(CIPO)is a rare but serious intestinal dyskinesia characterized by impaired bowel motor function in the absence of mechanical intestinal obstruction. CIPO may be caused by primary and secondary factors that damage the enteric nervous system(neuropathy),smooth muscle(myopathy),and/or Cajal interstitial cells(interstitial disease). CIPO is extremely easy to missed diagnosis and misdiagnosis.The treatment of CIPO is very difficult.It is based on nutritional support,medicine and surgical treatment.At present,the occurrence,development and treatment of intestinal micro-ecology in CIPO has gradually attracted attention and may become a new treatment method for CIPO.

Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility

BACKGROUND/AIMS: Previous studies from Korea have described chronic intestinal pseudo-obstruction (CIPO) patients with transition zone (TZ) in the colon. In this study, we evaluated the pathological characteristics and their association with long-term outcomes in Korean colonic pseudo-obstruction (CPO) patients with TZ. METHODS: We enrolled 39 CPO patients who were refractory to medical treatment and underwent colectomy between November 1989 and April 2016 (median age at symptoms onset: 45 [interquartile range, 29–57] years, males 46.2%). The TZ was defined as a colonic segment connecting a proximally dilated and distally non-dilated segment. Detailed pathologic analysis was performed. RESULTS: Among the 39 patients, 37 (94.9%) presented with TZ and 2 (5.1%) showed no definitive TZ. Median ganglion cell density in the TZ adjusted for the colonic circumference was significantly decreased compared to that in proximal dilated and distal non-dilated segments in TZ (+) patients (9.2 vs 254.3 and 150.5, P < 0.001). Among the TZ (+) patients, 6 showed additional pathologic findings including eosinophilic ganglionitis (n = 2), ulcers with combined cytomegalovirus infection (n = 2), diffuse ischemic changes (n = 1), and heterotropic myenteric plexus (n = 1). During follow-up (median, 61 months), 32 (82.1%) TZ (+) patients recovered without symptom recurrence after surgery. The presence of pathological features other than hypoganglionosis was an independent predictor of symptom recurrence after surgery (P = 0.046). CONCLUSIONS: Hypoganglionosis can be identified in the TZ of most Korean CPO patients. Detection of other pathological features in addition to TZ-associated hypoganglionosis was associated with poor post-operative outcomes.

Cecostomía endoscópica percutánea, una terapia eficaz en el síndrome de Ogilvie: relato de caso y revisión bibliográfica / Percutaneous endoscopic cecostomy, effective therapy for the treatment of Ogilvie syndrome: case and literature review

Ogilvie syndrome, or Acute Colonic Pseudo-Obstruction (ACPO) is characterized by colonic distension in the absence of mechanical obstruction. In general, it evolves favorably following a conservative treatment, and surgical procedures are not necessary6. We describe a case of ACPO with evolution of two days, in a 79-year old male patient, with asthma, type 2 diabetes mellitus, systemic arterial hypertension and policystic kidneys. After failure of conservative treatment based on support measures and neostigmine, percutaneous endoscopic support cecostomy, using a gastrostomy tube. The technique and its early execution were chosen considering that it was easy to be implemented, low cost and need for immediate colonic decompression due to high risk of ischemia and perforation of the colon, associated to a rapid clinical deterioration of the patient

El síndrome de Ogilvie o Pseudoobstrucción colónica aguda (ACPO) se caracteriza por la distensión del colon en ausencia de obstrucción mecánica. En general, el tratamiento conservador es favorable, no siendo necesaria una intervención quirúrgica. Describimos el caso de una ACPO con dos días de evolución, en paciente masculino de 79 años, asmático, portador de diabetes mellitus tipo 2, hipertensión arterial sistémica y riñones poliquísticos. Después del fracaso del tratamiento conservador con medidas de soporte y neostigmina, se optó por la realización de cecostomía endoscópica percutánea de protección, utilizando una sonda de gastrostomía. La elección de la técnica y su realización precoz se dio teniendo en vista su facilidad de ejecución, su bajo costo y la necesidad de descompresión colónica inmediata por el elevado riesgo de isquemia y perforación del colon, asociado al rápido empeoramiento clínico del paciente.