Ogilvie syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Supportive care is the first line of management of the colonic pseudo-obstruction. The supportive measures include treatment of the underlying cause of the obstruction, terminating the concurrent medications that may cause intestinal dysmotility, and administration of intravenous fluids and saline. Neostigmine can be used in the cases of pseudo-obstruction resistant to the supportive measures. Non-surgical techniques can be performed to decompress the obstructionand it includes colonoscopic decompression and percutaneous cecostomy.

• Supportive care is recommended in patients with colonic pseduo-obstruction in order to prevent the development of serious complications like intestinal perforation. It can be performed in the first few days after diagnosing the colonic pseudo-obstruction as long as there is no severe pain or extreme abdominal distension.^[1]
• The supportive measures include the following:^[2]
  • Following up and management any underlying cause like heart failure or infection
  • Terminating any concurrent medication that may cause intestinal dysmotility like opioids and calcium channel blockers
  • Administration of intravenous saline and fluids in order to preserve the normal body homeostasis
  • Placement of the patients in a prone position with elevation of the hips

• The first management approach of Ogilvie’s syndrome is the supportive care. If the pseudo-obstruction remains refractory, neostigmine is recommended.
• Neostigmine is an antidote, cholinergic cholinesterase inhibitor and autonomic nervous system agent that is FDA approved for the treatment of the reversal of the effects of non-depolarizing neuromuscular blocking agents after surgery.^[3]
• Common adverse reactions include hypotension, nausea, bradycardia, and vomiting. Hereby, atropine should be administrated when need for adverse effects reversal.^[4]
• Preferred regimen: 2mg slow IV infusion for interval of 3 to 5 minutes.

• A last management approach (before the surgical option) for the colonic pseudo-obstruction is the non surgical decompression of the obstruction.
• Non surgical decompression can be performed through the following:
  • Colonoscopic decompression:^[5][6]
    • Although decompression of the obstruction using the colonoscopy is difficult, it has shown high success rates in some studies.
    • Colonoscopic decompression must be performed carefully due to risk of perforation. Moreover, no administration of oral substances or enemas before the colonoscopy procedure to prevent the risk of aspiration.
  • Percutaneous cecostomy:^[7]
    • Using the endoscope and radiologic guidance, percutaneous cecostomy can be performed to relieve cases with acute colonic pseudo-obstruction.
    • As it is an invasive procedure, it carries risk of bleeding and infections.