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.

Acute colonic pseudo-obstruction syndrome in patients with severe COVID-19 in Buenos Aires, Argentina.

BACKGROUND: Several gastrointestinal complications have been reported in patients with COVID-19, including motility disorders, such as acute colonic pseudo-obstruction (ACPO). This affection is characterized by colonic distention in the absence of mechanical obstruction. ACPO in the context of severe COVID-19 may be related to neurotropism and direct damage of SARS-CoV-2 in enterocytes. METHOD: We conducted a retrospective study of patients who were hospitalized for critical COVID-19 and developed ACPO between March 2020 and September 2021. The diagnostic criteria to define ACPO was the presence of 2 or more of the following: abdominal distension, abdominal pain, and changes in the bowel movements, associated with distension of the colon in computed tomography. Data of sex, age, past medical history, treatment, and outcomes were collected. RESULTS: Five patients were detected. All required admission to the Intensive Care Unit. The ACPO syndrome developed with a mean of 33.8 days from the onset of symptoms. The mean duration of the ACPO syndrome was 24.6 days. The treatment included colonic decompression with placement of rectal and nasogastric tubes, endoscopy decompression in two patients, bowel rest, fluid, and electrolytes replacement. One patient died. The remaining resolved the gastrointestinal symptoms without surgery. CONCLUSIONS: ACPO is an infrequent complication in patients with COVID-19. It occurs especially in patients with critical condition, who require prolonged stays in intensive care and multiple pharmacological treatments. It is important to recognize its presence early and thus establish an appropriate treatment, since the risk of complications is high.

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.

Seudoobstrucción colónica aguda o síndrome de Ogilvie en una anciana / Acute colonic pseudo-obstruction or Ogilvie syndrome in an old woman

La seudoobstrucción colónica aguda o síndrome de Ogilvie es una afección en la cual hay apariencia clínica e imagenológica de obstrucción intestinal sin bloqueo mecánico. Se describe el caso clínico de una anciana de 65 años de edad, quien sufría esta condición clínica, por lo cual fue atendida en el Servicio de Cirugía del Hospital N´Gola Kimbanda, provincia Namibe en Angola e intervenida quirúrgicamente. La paciente evolucionó favorablemente y egresó sin dificultad

The acute colonic pseudo-obstruction or Ogilvie syndrome is a disorder in which there is a clinical and imagenologic appearance of intestinal obstruction without mechanic blockade. The case report of a 65 years old woman who suffered from this clinical condition is described, reason why she was assisted and surgically intervened in the Surgery Service of N´Gola Kimbanda Hospital, Namibe province in Angola. The patient had a favorable clinical course and she was discharged without difficulty

Síndrome de Ogilvie após parto cesárea: relato de caso / Ogilvie's Syndrome after caesarean section: case report

Introdução: Descrita por Heneage Ogilvie em 1948, a síndrome que leva seu nome é caracterizada por uma dilatação do cólon simulando uma obstrução mecânica, possivelmente por conta de uma supressão parassimpática, ou estímulo excessivo parassimpático, resultando em uma atonia do cólon. O tratamento pode ser conservador, cirúrgico ou por descompressão colonoscópica. Relato: K.R.S.R, 41 anos, mulher, recém operada (cesariana), foi admitida relatando dor, distensão abdominal, constipação, ausência de flatos e febre. Disse já ter procurado serviço médico com queixas de constipação intestinal e apresentava-se hipotensa, taquicárdica, SpO2 94% e desidratada. O abdômen encontrava-se globoso, distendido, tenso, doloroso difusamente à palpação profunda, Blumberg +, timpânico à percussão, 18.600 leucócitos, 7% de bastonetes, Hb: 15,8 Ht: 46% e plaquetas: 349.000/mm³. Foi internada e submetida a USG abdominal, rotina radiológica de abdômen agudo e TC abdominal. Submetida à laparotomia exploradora, constatando dilatação desde o cólon ascendente até o cólon sigmóide e uma perfuração do ceco com cerca de 1cm. Realizou-se a aspiração da cavidade, rafia da lesão cecal e drenagem utilizando-se dreno túbulo laminar. Com boa evolução, teve alta no 5° dia pós-operatório, retirando o dreno posteriormente. 20 dias após o procedimento, retornou relatando dor abdominal, sendo submetida à USG de abdome que revelou coleção na goteira parietocólica direita. Esta foi drenada através de videolaparoscopia e, após boa evolução, a paciente recebeu alta no 2° dia pós-operatório. Conclusão: São necessários mais estudos para aprofundar o conhecimento sobre a síndrome.

Introduction: Described by Heneage Ogilvie in 1948, the syndrome that bears his name is characterized by a dilation of the colon simulating a mechanical obstruction, possibly due to a parasympathetic suppression or excessive parasympathetic stimulation, resulting in an atony of the colon. The treatment may be conservative, surgical or by colonoscopic decompression. Report: K.R.S.R, 41 years old, female, newly operated (caesarean section), was admitted reporting pain, bloating, constipation, absence of flatus and fever. Said she had sought medical service with constipation complaints and the patient was hypotensive, tachycardic, SpO2 94% and dehydrated. The abdomen was globose, distended, tense, painful diffusely to deep palpation, Blumberg +, tympanic to percussion, 18,600 leukocytes, 7% rods, Hb: 15.8 Ht: 46% and platelets: 349,000 / mm³. She was hospitalized and underwent to an abdominal ultrasonography, radiological routine, acute abdomen and abdominal CT. Submitted to laparotomy, finding dilation from the ascending colon to the sigmoid colon and cecal perforation of about 1cm. It carried out the suction cavity, suture the cecal lesion and drainage using laminar drain tubule. With good performance, she was discharged on the 5th postoperative day, removing the drain later that day. 20 days after the procedure, she returned reporting abdominal pain and was submitted to an abdomen USG revealed that the collection in the right parieto-colic drip. This was drained by laparoscopy and, after good performance, the patient was discharged on the 2nd postoperative day. Conclusion: Further studies are needed to increase knowledge about the syndrome.

[Dysmorphic neonatal syndrome and Ogilvie syndrome]. / Síndrome dismórfico neonatal y síndrome de Ogilvie.

BACKGROUND: Acute colonic pseudo-obstruction, or Ogilvie syndrome, is a motility abnormality characterised by rapid and progressive dilation of the large intestine. To achieve a diagnosis it is fundamental to exclude mechanical obstruction with imaging studies such as computer axial tomography. The combined incidence of Ogilvie and dysmorphic syndrome has not been described. CLINICAL CASE: Female patient of 28 years old with a history of infant cerebral palsy came to emergency room with 4 days of intestinal obstruction. She had hypokalaemia that was reverted, but persisted with obstruction. Later after 72h with recovery of fluids and electrolytes and administration of prokinetics, the obstruction reversed. She was discharged with no complications. CONCLUSIONS: Non-invasive medical treatment solves most cases. Promising results have been achieved with neostigmine. In the event of no response to drug therapy, the next step is endoscopic treatment. Even with high recurrence this is preferred due to its lower level of complications in contrast to surgical decompression. Neonatal dysmorphic syndrome is often associated with disorders of the central nervous system. So far, there have been no reports on the incidence of this disease with Ogilvie syndrome, although 9% of cases have been described as associated with neurological events. Conservative management in this disease is the initial approach. Interventions should be reserved for when conservative treatment fails.

Síndrome de Ogilvie poshisterectomía: reporte de un caso y revisión de la literatura(AU) / Ogilvie's syndrome post hysterectomy: a case report and literature review

Objetivo: presentar el estudio y el tratamiento que se le realizó a una mujer embarazada que presentó Síndrome de Ogilvie (SO) como complicación de una histerectomía obstétrica, así como describir la epidemiología,lafisiopatología,loshallazgosclínicos después de los procedimientos gineco-obstétricos y el tratamiento de esta patología mediante una revisión de la literatura. Presentación del caso: mujer de 28 años de edad con embarazo de 38 semanas de gestación quien después de parto vaginal eutócico sufrió atonía uterina. Debido a la falta de mejoría con el manejo médico, se le realizó una histerectomía abdominal subtotal, presentando picos febriles, intolerancia a la vía oral, taquicardia, distensión e hipertimpanismo abdominal con dolor a la palpación superficial y profunda en hemiabdomen derecho y peristaltismo disminuido durante el posoperatorio. La radiografía de abdomen evidenció un cuadro obstructivo con origen probable a nivel del intestino delgado, por lo que se le practicó una laparotomía exploratoria donde se le encontró peritonitis fecal y perforación colónica a nivel de la válvula ileocecal, sin evidencia de obstrucción mecánica. Discusión: el SO se caracteriza por la dilatación masiva y progresiva del colon en ausencia de una obstrucción mecánica. Se desarrolla principalmente en pacientes hospitalizadas con graves condiciones médico-quirúrgicas, pero también se presenta frecuentemente después de procedimientos gineco-obstétricos. Debido a que este síndrome se ha visto asociado con una alta morbimortalidad, es necesario que el gineco-obstetra lo tenga en cuenta como diagnóstico diferencial y esté atento a su presentación como complicación de cirugías obstétricas o ginecológicas.

Objective: presenting the workup and management of a pregnant woman who presented Ogilvie's syndrome as a complication of an obstetric hysterectomy and describing the epidemiology, physiopathology and clinical findings following gynecobstetric procedure and treatment of this pathology by means of a literature review. Case report: the case of a 28-year-old woman is presented; the patient presented uterine atony following normal vaginal delivery after 38 weeks' pregnancy. A subtotal abdominal hysterectomy was made due to lack of improvement with medical management. The patient presented fever, intolerance to oral route, tachycardia, distended and hypertympanic abdomen, pain in response to surface and deep palpation of the right hemi-abdomen and decreased peristalsis during postoperative period. The abdominal radiograph revealed obstruction of the small intestine; exploratory laparotomy was thus carried out, showing foetal peritonitis and perforation of the colon at the ileocecal valve without evidence of mechanical obstruction. Discussion: Ogilvie's syndrome is characterised by massive and progressive dilatation of the colon in the absence of small bowel obstruction. The syndrome mainly develops in hospitalised patients suffering from severe medical conditions; nonetheless, it also occurs after gynecobstetric procedures. Because this syndrome is associated with high rates of morbidity andmortality,thegynecobstetricianmustrecognise this syndrome as being a possible complication of gynecobstetric procedure.

Síndrome de Ogilvie (pseudo-obstrução intestinal aguda) - Relato de caso / Ogilvie's Syndrome (Acute pseudo-intestinal obstruction) - A case report

RACIONAL: A síndrome de Ogilvie é condição clínica com sinais, sintomas e aparência radiológica de dilatação acentuada do cólon sem causa mecânica e pode complicar com rompimento da parede do cólon e sepse abdominal. O tratamento na maioria das vezes é cirúrgico. RELATO DO CASO: Paciente feminina, 49 anos, internada com queixa de dor abdominal e diarréia e apresentando-se confusa, desidratada, taquicárdica, dispnéica, temperatura de 38ºC, abdômen distendido, ausência de ruídos hidro-aéreos e toque retal com fezes pastosas. Estudo radiográfico mostrou padrão de pseudo-obstrução intestinal. A paciente evoluiu com parada de eliminação de gases e fezes e sinais de abdômen agudo infeccioso. Foi submetida à laparotomia com achado de ceco e transverso bastante dilatados e sem sinal de obstrução mecânica. Realizada colectomia subtotal com fechamento do coto distal e ileostomia terminal. CONCLUSÃO: Pensar nessa possibilidade diagnóstica e agir mais rapidamente é a única possibilidade de diminuir a morbimortalidade desses pacientes.

BACKGROUND: The Ogilvie's Syndrome is a clinical condition with signals, symptoms and radiological appearance of large bowel swell without mechanical cause. This obstruction can complicate with disruption of the bowel and consequent evolution of abdominal sepse. The treatment is typically surgical. AIM: The aim of this work is report a case of Ogilvie's Syndrome. CASE REPORT: Feminine patient, 49 years-old, interned with a history of abdominal pain and diarrhea and presenting dehydratation, tachycardia , dyspnea, mental confusion, 38ºC of temperature, distended abdomen, absence of hydro-aerial noises and rectal touch with pasty excrements. The x-ray showed a standard of pseudo-intestinal obstruction. The patient evolved with stop of elimination of farts and excrements and signals of infectious acute abdomen. The laparotomy showed cecum and transverse very swelled without signal of mechanical obstruction. The treatment was a subtotal colectomy with closing of the rectal stump and terminal ileostomy. CONCLUSION: This is rare syndrome and cases like this must be described for a faster diagnostic and adequate treatment, reducing the morbimortality of these patients.