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Jagirdhar GSK, Elmati PR, Pattnaik H, Shah M, Surani S. Navigating gastrointestinal endoscopy challenges in the intensive care unit: A mini review. World J Crit Care Med 2024; 13:100121. [PMID: 39655307 PMCID: PMC11577537 DOI: 10.5492/wjccm.v13.i4.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 10/08/2024] [Accepted: 10/22/2024] [Indexed: 10/31/2024] Open
Abstract
Patients in the intensive care unit (ICU) may need bedside endoscopy for gastrointestinal (GI) emergencies. Conducting endoscopy in the ICU for critically ill patients needs special consideration. This mini review focuses on indications for bedside endoscopes, including GI bleeding, volvulus, and bowel obstruction. It explains the risks associated with urgent endoscopies in critical patients and outcomes. Hemodynamic instability, coagulopathy, and impaired mucosal visualization are important considerations before bedside endoscopy. It also discusses the anesthesia considerations for non-operating room anesthesia. Multidisciplinary collaboration, meticulous patient selection, and procedural optimization help mitigate risks and maximize procedural success.
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Affiliation(s)
| | - Praveen Reddy Elmati
- Department of Anesthesiology, Saint Clair Hospital, Dover, NJ 07801, United States
| | - Harsha Pattnaik
- Department of Medicine, Lady Hardinge Medical College, New Delhi 110001, India
| | - Mehul Shah
- Department of Gastroenterology, Saint Michaels Medical Center Newark, Newark, NJ 07104, United States
| | - Salim Surani
- Department of Medicine and Pharmacology, Texas A and M University, College Station, TX 77843, United States
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Johnny CS, Schlegel RN, Balachandran M, Casey L, Mathew J, Carne P, Varma D, Ban EJ, Fitzgerald MC. Acute colonic pseudo-obstruction in polytrauma patients. J Trauma Acute Care Surg 2024; 97:614-622. [PMID: 38769618 DOI: 10.1097/ta.0000000000004392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aimed to explore risk factors and clinical outcomes of ACPO in polytrauma patients and contribute information to the limited literature on this condition. METHODS This retrospective study, conducted at a Level 1 trauma center, analyzed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was used. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors. RESULTS There were 57 cases of ACPO, with an incidence of 1.7 per 1,000 patients, rising to 4.86 in major trauma. Predominantly affecting those older than 50 years (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPBs) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and shock index >0.9, Injury Severity Score >18, opioid use, RPBs, and pelvic fractures. A cecal diameter of ≥12 cm had a significant association with cecal ischemia or perforation. CONCLUSION This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPBs, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favorable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Cecil S Johnny
- From the Trauma Service (C.S.J., R.N.S., M.B., L.C., J.M., E.-J.B., M.C.F.), Emergency and Trauma Centre (C.S.J., J.M.), and National Trauma Research Institute (C.S.J., J.M., E.-J.B., M.C.F.), The Alfred Hospital; Department of Surgery (C.S.J., J.M., M.C.F.), Central Clinical School, Monash University; Colorectal Unit, Department of Surgery (P.C.), Department of Radiology (D.V.), and Acute General Surgery Unit (E.-J.B.), The Alfred Hospital, Melbourne, Victoria, Australia
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3
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Aboelezz AF, Othman MO. Endoscopic Management of Colonic Obstruction. Gastrointest Endosc Clin N Am 2024; 34:141-153. [PMID: 37973225 DOI: 10.1016/j.giec.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional (pseudo-obstruction), or mechanical conditions. Benign etiologies of colonic obstructions include colon volvulus, anastomotic strictures, radiation injury, ischemia, inflammatory processes such as Crohn's disease, diverticulitis, bezoars, and intussusception.
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Affiliation(s)
- Ahmad F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Faculty of Medicine, Tanta University, El Bahr Street, Tanta Qism 2, Tanta 1, Gharbia Governorate 31111, Egypt
| | - Mohamed O Othman
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Gastroenterology Section at Baylor St Luke's Medical Center, 7200 Cambridge Street. Suite 8A, Houston, TX 77030, USA.
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4
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Mahdi A, Bharwad A, Mahdi M, Rowe K. Acute Colonic Pseudo-Obstruction in a Patient With COVID-19 Pneumonia: A Case Report. Cureus 2023; 15:e36251. [PMID: 37065360 PMCID: PMC10103820 DOI: 10.7759/cureus.36251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Coronavirus disease (COVID-19) is primarily a respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. However, the disease is also known to cause a range of extrapulmonary manifestations, including gastrointestinal (GI) symptoms such as nausea, vomiting, and diarrhea. The exact mechanisms by which the virus causes extrapulmonary manifestations are not fully understood, but it is theorized that the virus can enter cells in other organs including the GI tract, through the angiotensin-converting enzyme 2 (ACE2) receptor. This can result in inflammation and damage to the affected organs. In rare cases, COVID-19 can also cause acute colonic pseudo-obstruction (ACPO), a condition characterized by symptoms of bowel obstruction but without a physical obstruction present. Acute colonic pseudo-obstruction is a serious and potentially life-threatening complication of COVID-19 that requires prompt recognition and treatment to prevent further complications such as bowel ischemia and perforation. We hereby present a case report of a patient with COVID-19 pneumonia developing ACPO and discuss the suggested pathophysiology, diagnostic approach, and treatment options.
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Clozapine and Ogilvie syndrome in Schizophrenia: Case report of a successful rechallenge. Asian J Psychiatr 2022; 77:103249. [PMID: 36095882 DOI: 10.1016/j.ajp.2022.103249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
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Gastrointestinal Dysmotility in Critically Ill Patients: Bridging the Gap Between Evidence and Common Misconceptions. J Clin Gastroenterol 2022; 57:440-450. [PMID: 36227004 DOI: 10.1097/mcg.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disruption of normal gastrointestinal (GI) function in critical illness is linked to increased morbidity and mortality, and GI dysmotility is frequently observed in patients who are critically ill. Despite its high prevalence, the diagnosis and management of GI motility problems in the intensive care unit remain very challenging, given that critically ill patients often cannot verbalize symptoms and the general lack of understanding of underlying pathophysiology. Common clinical presentations of GI dysmotility issues among critically ill patients include: (1) high gastric residual volumes, acid reflux, and vomiting, (2) abdominal distention, and (3) diarrhea. In this review, we discuss the differential diagnosis for intensive care unit patients with symptoms and signs concerning GI motility issues. There are many myths and longstanding misconceptions about the diagnosis and management of GI dysmotility in critical illness. Here, we uncover these myths and discuss relevant evidence in each subject area, with the goal of re-conceptualizing GI motility disorders in critical care and providing evidence-based recommendations for clinical care.
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Prompt intervention in large bowel obstruction management: A Nationwide Inpatient Sample analysis. Am J Surg 2022; 224:1262-1266. [DOI: 10.1016/j.amjsurg.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/03/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022]
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Mullen ND, Thurn H, Karr E, Burtson KM. Non-toxic Megacolon Secondary to High-Grade Large-Bowel Obstruction. Cureus 2022; 14:e21580. [PMID: 35228938 PMCID: PMC8867426 DOI: 10.7759/cureus.21580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
A 92-year-old male presented from an outside hospital for treatment of a chronic obstructive pulmonary disease exacerbation (COPD) and subsequently developed worsening abdominal distention with pain during the course of his hospitalization. He was found to have a high-grade large-bowel obstruction with a dilated colon of 20 cm measuring upward. The patient ultimately underwent a hemicolectomy to prevent bowel ischemia and reformation of another volvulus. We present this case to elucidate the need for vigilant monitoring in patients with chronic bowel obstruction due to lack of typical symptoms, to demonstrate a successful management approach, and to exhibit an extreme example of the resulting megacolon.
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Underhill J, Munding E, Hayden D. Acute Colonic Pseudo-obstruction and Volvulus: Pathophysiology, Evaluation, and Treatment. Clin Colon Rectal Surg 2021; 34:242-250. [PMID: 34305473 DOI: 10.1055/s-0041-1727195] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute colonic pseudo-obstruction (ACPO) and volvulus are two disease processes that affect the colon causing abdominal distension and may necessitate operation intervention. ACPO may be associated with multiple comorbidities, infectious diseases, and cardiac dysfunction. It may be treated with conservative management including endoscopic decompression or neostigmine. If the distension is not addressed, high mortality may result if peritonitis develops. Volvulus most commonly occurs in the sigmoid colon or cecum. If left-sided, endoscopic decompression may resolve the obstruction if detorsion is successful, although sigmoid colectomy should be performed during the admission. If cecal volvulus is identified, right hemicolectomy should be performed.
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Affiliation(s)
- Joshua Underhill
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Emily Munding
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Dana Hayden
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
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10
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Jaber A, Hemmer S, Klotz R, Ferbert T, Hensel C, Eisner C, Ryang YM, Obid P, Friedrich K, Pepke W, Akbar M. Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital. DER ORTHOPADE 2021; 50:425-434. [PMID: 33185695 DOI: 10.1007/s00132-020-04034-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury. OBJECTIVE The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated. MATERIAL AND METHODS An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included. RESULTS Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care. CONCLUSION Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.
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Affiliation(s)
- A Jaber
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - S Hemmer
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - R Klotz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - T Ferbert
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - C Hensel
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - C Eisner
- Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Y M Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - P Obid
- Spinal Surgery and Scoliosis Centre, Asklepios Paulinen Clinic, Geisenheimer Straße 10, 65197, Wiesbaden, Germany
| | - K Friedrich
- Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - W Pepke
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - M Akbar
- MEOCLINIC GmbH, Friedrichstraße 71, 10117, Berlin, Germany.
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11
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Chiacchio S, Lowe MC. Stretched to the Max: The Successful Medical Management of Ogilvie Syndrome in a Pediatric Patient. Cureus 2021; 13:e14506. [PMID: 34007759 PMCID: PMC8124019 DOI: 10.7759/cureus.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ogilvie syndrome, or acute colonic pseudo-obstruction, is a rare disease in adults, and it is seldom seen in pediatric patients. It was first described in 1948 by Dr. William Ogilvie. Unless promptly recognized and treated, it carries the risk of colonic ischemia and perforation. In this report, we present the case of a 10-year-old patient who developed Ogilvie syndrome and was successfully treated with conservative medical management including bowel rest, rectal decompression, along with the addition of erythromycin. The patient responded well to the treatment and was able to be discharged home without event.
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Affiliation(s)
- Stephany Chiacchio
- Pediatrics/Emergency Medicine, The University of Arizona, Banner-Diamond Children's Medical Center, Tucson, USA
| | - Merlin C Lowe
- Pediatrics/Hospital Medicine, The University of Arizona, Banner-Diamond Children's Medical Center, Tucson, USA
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12
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Naveed M, Jamil LH, Fujii-Lau LL, Al-Haddad M, Buxbaum JL, Fishman DS, Jue TL, Law JK, Lee JK, Qumseya BJ, Sawhney MS, Thosani N, Storm AC, Calderwood AH, Khashab MA, Wani SB. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc 2020; 91:228-235. [PMID: 31791596 DOI: 10.1016/j.gie.2019.09.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
Colonic volvulus and acute colonic pseudo-obstruction (ACPO) are 2 causes of benign large-bowel obstruction. Colonic volvulus occurs most commonly in the sigmoid colon as a result of bowel twisting along its mesenteric axis. In contrast, the exact pathophysiology of ACPO is poorly understood, with the prevailing hypothesis being altered regulation of colonic function by the autonomic nervous system resulting in colonic distention in the absence of mechanical blockage. Prompt diagnosis and intervention leads to improved outcomes for both diagnoses. Endoscopy may play a role in the evaluation and management of both entities. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO.
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Affiliation(s)
- Mariam Naveed
- Advent Health Medical Group, Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA
| | - Laith H Jamil
- Division of Gastroenterology and Hepatology, Beaumont, Royal Oak, Royal Oak, Michigan, USA
| | | | - Mohammad Al-Haddad
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Douglas S Fishman
- Department of Gastroenterology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Terry L Jue
- The Permanente Medical Group, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Joanna K Law
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, Archbold Medical Group, Thomasville, Georgia, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Andrew C Storm
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey H Calderwood
- Department of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sachin B Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
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13
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Abstract
BACKGROUND Colonoscopic decompression is performed in inpatients for management of acute colonic pseudo-obstruction. Evidence for its efficacy is limited to small descriptive studies published before the use of neostigmine for acute colonic pseudo-obstruction. Furthermore, therapeutic end points were not defined. OBJECTIVE The aim was to compare the effectiveness of colonic decompression with standard medical therapy (supportive and pharmacologic therapy) to standard medical therapy alone. DESIGN This is a retrospective, propensity-matched study. SETTING The study was conducted at a tertiary care center. PATIENTS Inpatients with first diagnosis of acute colonic pseudo-obstruction between 2000 and 2016 were selected. INTERVENTIONS The intervention group received colonic decompression as well as supportive and/or pharmacologic therapy. The control group did not receive colonic decompression. MAIN OUTCOME MEASURES The primary outcome was the resolution of overall colonic dilation on imaging 48 hours following colonic decompression or the initiation of standard medical therapy alone. Secondary outcomes included symptom improvement, colonic segment diameter percentage change, perforation, 30-day readmission, and all-cause mortality. RESULTS The standard medical therapy and colonic decompression groups included 61 and 83 patients. Of the patients who underwent colonic decompression, 47.7% had complete resolution of acute colonic pseudo-obstruction versus 19.9% of patients who underwent standard medical therapy (p < 0.001). There were no significant differences in mid or distal colon diameter reduction between groups. The 30-day readmission rate was 15.7% in the colonic decompression group versus 26.2% in the standard medical therapy group. No immediate adverse events were noted in either group. Thirty-day all-cause mortality was 8.4% for the colonic decompression group and 14.8% in the standard medical therapy group. LIMITATIONS The study was a retrospective review on a highly comorbid population. CONCLUSIONS Colonic decompression is effective compared to standard medical therapy alone for proximal colonic dilation or symptoms associated with acute colonic pseudo-obstruction. On segmental analysis, colonic decompression does not provide any additional benefit over standard medical therapy in improving transverse or distal colonic dilation. See Video Abstract at http://links.lww.com/DCR/B32. LA DESCOMPRESIÓN COLÓNICA REDUCE LA PSEUDOOBSTRUCCIÓN COLÓNICA AGUDA PROXIMAL Y LOS SÍNTOMAS RELACIONADOS.: La descompresión colonica se realiza en pacientes hospitalizados para el tratamiento de la pseudoobstrucción colónica aguda. La evidencia de su eficacia se limita a pequeños estudios descriptivos antes del uso de neostigmina para la pseudoobstrucción colónica aguda. Además, los puntos finales terapéuticos no se definieron.El objetivo fue comparar la efectividad de la descompresión colónica mas el tratamiento médico estándar (tratamiento de apoyo y farmacológico) contra el tratamiento médico estándar solamente.Este es un estudio retrospectivo de propensión coincidente.El estudio se realizó en un centro de atención de tercer nivel.Pacientes hospitalizados con diagnóstico de pseudoobstrucción colónica aguda entre 2000 y 2016.El grupo de intervención recibió descompresión colónica, así como tratamiento de apoyo o farmacológica. El grupo control no recibió descompresión colónica.La medida de resultado primaria fue la resolución de la dilatación colónica general en la imagen 48 horas después de la descompresión colónica o el inicio del tratamiento médico estándar solo. Los resultados secundarios incluyeron mejoría de los síntomas, cambio porcentual en el diámetro del segmento colónico, perforación, reingreso a los 30 días y mortalidad por cualquier causa.La terapia médica estándar y los grupos de descompresión colónica incluyeron 61 y 83 pacientes, respectivamente. El 47,7% de los pacientes con descompresión colónica tuvieron una resolución completa de la pseudoobstrucción colónica aguda frente al 19,9% de los pacientes con terapia médica estándar (p < 0,001). No hubo diferencias significativas en la reducción del diámetro del colon medio o distal entre los grupos. La tasa de reingreso a los 30 días fue del 15,7% en el grupo de descompresión colónica frente al 26,2% en el grupo de tratamiento médico estándar. No se observaron eventos adversos inmediatos en ninguno de los dos grupos. La mortalidad por cualquier causa a los 30 días fue del 8.4% para la descompresión del colon y del 14.8% en los grupos de terapia médica estándar.El estudio fue una revisión retrospectiva en una población altamente comórbida.La descompresión colónica es efectiva en comparación con el tratamiento médico estándar solo para la dilatación del colon proximal o los síntomas asociados con la pseudoobstrucción colónica aguda. En el análisis segmentario, la descompresión colónica no proporciona ningún beneficio adicional sobre el tratamiento médica estándar para mejorar la dilatación colónica transversal o distal. Vea el resumen del video en http://links.lww.com/DCR/B32.
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İlban Ö, Çiçekçi F, Çelik JB, Baş MA, Duman A. Neostigmine treatment protocols applied in acute colonic pseudo-obstruction disease: A retrospective comparative study. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:228-233. [PMID: 30541715 DOI: 10.5152/tjg.2018.18193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIMS When conservative methods fail, neostigmine is recommended in the pharmacological treatment of acute colonic pseudo-obstruction (ACPO). The objective of this study was to analyze the response of patients to different neostigmine protocols. MATERIALS AND METHODS Patients diagnosed with ACPO in the intensive care unit between January 2015 and September 2017 were retrospectively studied. Either of the two neostigmine protocols, the bolus dose (BD) or continuous infusion (CI), was applied to the ACPO patients who were unresponsive to conservative treatments, and the results were analyzed. RESULTS In 79 of 122 (64%) patients, the resolution of symptoms was observed with conservative treatments. Of 43 patients who did not respond to conservative treatments, 20 were applied neostigmine as BD, and 23 were applied by CI. A total of 55% of patients in the BD group and 60.9% patients in the CI group responded to neostigmine therapy after the first dose. The group-specific protocols were reapplied in patients unresponsive to the first dose. A total of 25% in the BD group and 8.7% in the CI group responded to the second dose treatment. As a result, 80% of patients from the BD group and 69.6% from the CI group responded to neostigmine therapy. Although an overall response rate was higher in the BD group, there was no significant difference between groups (P=0.322). Colonic complications were observed in 2 patients, 1 from each group. There were no major side effects requiring treatment cessation. CONCLUSION The safety and effectiveness of both neostigmine protocols applied to ACPO patients were similar. Clinical and radiological responses were obtained without serious side effects with CI.
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Affiliation(s)
- Ömür İlban
- Department of Anaesthesiology, Selçuk University School of Medicine, Konya, Turkey
| | - Faruk Çiçekçi
- Department of Anaesthesiology, Selçuk University School of Medicine, Konya, Turkey
| | - Jale Bengi Çelik
- Department of Anaesthesiology, Selçuk University School of Medicine, Konya, Turkey
| | - Mehmet Ali Baş
- Department of Anaesthesiology, Selçuk University School of Medicine, Konya, Turkey
| | - Ateş Duman
- Department of Anaesthesiology, Selçuk University School of Medicine, Konya, Turkey
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Jeong SJ, Park J. Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction. Clin Endosc 2019; 53:18-28. [PMID: 31645090 PMCID: PMC7003002 DOI: 10.5946/ce.2019.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023] Open
Abstract
There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.
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Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Harnsberger CR. Acute colonic pseudo-obstruction (Ogilvie's syndrome). SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Orbion A, Mouman A, Behr J, Lakkis Z, Calame P, Delabrousse E. Correlation between a continent ileocecal valve and CT signs of severity in patients presenting with obstructive colonic cancer. Emerg Radiol 2019; 26:277-282. [PMID: 30656481 DOI: 10.1007/s10140-018-01667-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study the association of a continent ileocecal valve and the degree of severity of the CT signs in patients presenting with large bowel obstruction due to colonic cancer. PATIENTS AND METHODS Sixty-six patients undergoing emergency surgery for confirmed obstructive colonic cancer were included. The CT examinations were analyzed without consultation of the surgical results. For each patient, the diameter of the cecum at its widest point and that of the last ileal loop were measured. The ileocecal valve was considered incontinent when there was a distension of the last ileal loop greater than or equal to 25 mm. Below 25 mm, the ileocecal valve was considered continent. The presence of CT signs of severity of the LBO was noted, i.e., intestinal pneumatosis, absence of contrast enhancement of the large bowel wall, defect in the large bowel wall, and presence of extra-digestive air and ascites. RESULTS Among the 66 patients included, 42 had an incontinent ileocecal valve and 24 had a continental ileocecal valve. There was a statistically significant difference between the two groups in the diametrical measurements of the cecum's widest point (mean diameter measured at 10.3 cm in patients with continent ileocecal valve vs 8.4 cm in patients with incontinent ileocecal valve, P = 0.0023). Patients with a continent valve had statistically higher rates of CT severity (79% vs 40%, P < 0.005). Perforation of the cecum remained rare (8%) and was only observed in patients with continent ileocecal valve in our series. CONCLUSION Continence of the ileocecal valve appears to be statistically correlated both with cecum distension and the presence of CT signs of severity in patients with obstructive colonic cancer. As such, its presence must be retained as a risk factor for a pejorative evolution of this type of LBO and must be specified in the CT report of these patients.
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Affiliation(s)
- Alexandre Orbion
- Department of Radiology, Besançon University Hospital, 3 boulevard Fleming, 25030, Besançon, France
| | - Abdellah Mouman
- Department of Radiology, Besançon University Hospital, 3 boulevard Fleming, 25030, Besançon, France
| | - Julien Behr
- Department of Radiology, Besançon University Hospital, 3 boulevard Fleming, 25030, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery, Besançon University Hospital, 3 boulevard Fleming, 25030, Besançon, France
| | - Paul Calame
- Department of Radiology, Besançon University Hospital, 3 boulevard Fleming, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, Besançon University Hospital, 3 boulevard Fleming, 25030, Besançon, France. .,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, Besançon, France. .,Service de Radiologie Viscérale, CHRU Besançon, Hôpital Jean Minjoz, 3 Boulevard Fleming, 25030, Besançon, France.
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Wells CI, O’Grady G, Bissett IP. Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms. World J Gastroenterol 2017; 23:5634-5644. [PMID: 28852322 PMCID: PMC5558126 DOI: 10.3748/wjg.v23.i30.5634] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 07/22/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODS A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTS No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSION Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
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Vazquez-Sandoval A, Ghamande S, Surani S. Critically ill patients and gut motility: Are we addressing it? World J Gastrointest Pharmacol Ther 2017; 8:174-179. [PMID: 28828195 PMCID: PMC5547375 DOI: 10.4292/wjgpt.v8.i3.174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/18/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) dysmotility is a common problem in the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance (nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources.
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Awotar GK, Guan G, Sun W, Yu H, Zhu M, Cui X, Liu J, Chen J, Yang B, Lin J, Deng Z, Luo J, Wang C, Nur OA, Dhiman P, Liu P, Luo F. Reviewing the Management of Obstructive Left Colon Cancer: Assessing the Feasibility of the One-stage Resection and Anastomosis After Intraoperative Colonic Irrigation. Clin Colorectal Cancer 2017; 16:e89-e103. [PMID: 28254356 DOI: 10.1016/j.clcc.2016.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/01/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The management of obstructive left colon cancer (OLCC) remains debatable with the single-stage procedure of primary colonic anastomosis after cancer resection and on-table intracolonic lavage now being supported. PATIENTS AND METHODS Patients with acute OLCC who were admitted between January 2008 and January 2015 were distributed into 5 different groups. Group ICI underwent emergency laparotomy for primary anastomosis following colonic resection and intraoperative colonic lavage; Group HP underwent emergency Hartmann's Procedure; Group CON consisted of patients treated by conservative management with subsequent elective open cancer resection; Group COL were colostomy patients; and Group INT consisted of patients who had interventional radiology followed by open elective colon cancer resection. The demographics of the patients and comorbidity, intraoperative data, and postoperative data were collected, with P < .05 as significant. RESULTS There were 4 deaths in 138 cases (2.90%). There was only 1 patient who had anastomotic leakage (5.56%) in Group ICI, compared with none in Group HP and Group COL, 1 case in Group INT (7.69%), and 2 cases in Group CON (6.06%) (P > .05). Group INT and Group CON, when compared to the three surgical groups, Groups ICI, Group COL, and Group HP, individually, were statistically significant for the duration of surgery (P < .05). CONCLUSIONS Primary anastomosis following colonic resection after irrigation can be safely performed in selected patients, with the necessary surgical expertise, with no increased risk in mortality, anastomotic leakage, and other postoperative complications.
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Affiliation(s)
- Gavish Kumar Awotar
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Guoxin Guan
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Wei Sun
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Hongliang Yu
- Department of General Surgery, The Third Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Ming Zhu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Xinye Cui
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Jie Liu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Jiaxi Chen
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Baoshun Yang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Jianyu Lin
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Zeyong Deng
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Jianwei Luo
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Chen Wang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Osman Abdifatah Nur
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Pankaj Dhiman
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China
| | - Pixu Liu
- Institute of Cancer Stem Cell & College of Pharmacy, Dalian Medical University, Dalian, China
| | - Fuwen Luo
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, PR China.
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Krishnakumar R, Kuzhimattam MJ, Kumar G. Ogilvie's syndrome following posterior spinal instrumentation in thoraco lumbar trauma. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:179-82. [PMID: 26692695 PMCID: PMC4660494 DOI: 10.4103/0974-8237.167866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: To report unique cases of Ogilvie's syndrome (acute intestinal pseudo-obstruction) following posterior spinal instrumentation in thoraco lumbar trauma. Materials and Methods: A single centre retrospective study. We reviewed the surgical data of 420 patients who underwent thoracolumbar spinal surgery over a period of four years. Two patients who developed post operative Ogilvie's syndromes were identified. Results: The clinical presentation and blood investigations ruled out any infectious pathology. Computed tomography scans ruled out the mechanical obstruction. All patients improved with conservative management. Conclusion: Ogilvie's syndrome should be considered as a differential diagnosis in patients with postoperative significant abdominal distension who had undergone posterior instrumentation for spinal trauma. Early recognition and appropriate conservative treatment would be necessary to prevent complications such as bowel ischemia and perforation.
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Affiliation(s)
- R Krishnakumar
- Department of Orthopaedics, Spine Division, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Mathew John Kuzhimattam
- Department of Orthopaedics, Spine Division, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Gaurav Kumar
- Department of Orthopaedics, Spine Division, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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Cebola M, Eddy E, Davis S, Chin-Lenn L. Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) Following Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2015; 22:1307-10. [DOI: 10.1016/j.jmig.2015.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/27/2015] [Accepted: 06/29/2015] [Indexed: 01/31/2023]
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Jaffe T, Thompson WM. Large-Bowel Obstruction in the Adult: Classic Radiographic and CT Findings, Etiology, and Mimics. Radiology 2015; 275:651-63. [PMID: 25997131 DOI: 10.1148/radiol.2015140916] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Large-bowel obstruction is an abdominal emergency with high morbidity and mortality rates if left untreated. Although abdominal radiography is usually the initial imaging study performed in patients suspected of having large-bowel obstruction, it may not be sufficient to distinguish obstruction from other causes of colonic dilatation. Computed tomography is the imaging method of choice as it can establish the diagnosis and cause of large-bowel obstruction. A contrast agent enema may be used to confirm or exclude large-bowel obstruction. In this review, the imaging findings in multiple causes of large-bowel obstruction are illustrated and compared with acute colonic pseudo-obstruction.
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Affiliation(s)
- Tracy Jaffe
- From the Department of Radiology, Duke University Medical School, Box 3808, Durham, NC 27710 (T.J.); Department of Radiology, Veterans Administration Hospital, Albuquerque, NM (W.M.T.); and Department of Radiology, University of New Mexico, Albuquerque, NM (W.M.T.)
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Reeves M, Frizelle F, Wakeman C, Parker C. Acute colonic pseudo-obstruction in pregnancy. ANZ J Surg 2015; 85:728-33. [PMID: 26044983 DOI: 10.1111/ans.13201] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute colonic pseudo-obstruction is an uncommon but potentially morbid complication of pregnancy. The aim of the study was to review a single institution's experience with acute colonic pseudo-obstruction in post-partum patients and develop an algorithm for management based on a literature review. METHODS This is a retrospective study where patients were identified over a 2-year period (1 December 2012 to 31 November 2014) by checking all deliveries in Christchurch Women's Hospital against diagnosis codes for bowel obstruction and ileus. Clinical records and radiology were then reviewed to identify those with acute colonic pseudo-obstruction and the management of these patients was reviewed. RESULTS Over the study period, seven patients were identified from 10,240 deliveries. Two patients required laparotomy and the rest resolved without surgical intervention. One patient was treated with neostigmine and three with erythromycin. One patient had an unsuccessful attempt at endoscopic decompression, however, symptoms resolved without further intervention following this. A management algorithm was developed based on the literature review. CONCLUSIONS Acute colonic pseudo-obstruction occurs in post-partum patients more frequently than suspected (one in 1500 deliveries). The management needs to be active with early correction of electrolyte abnormalities, avoidance of narcotic pain relief and early mobilization. Timely administration of neostigmine or endoscopic decompression can reduce the incidence of colonic ischaemia and perforation and the need for surgical intervention.
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Affiliation(s)
- Michael Reeves
- Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Frank Frizelle
- Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Christopher Wakeman
- Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Catherine Parker
- Department of Surgery, Christchurch Hospital and University of Otago, Christchurch, New Zealand
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Tewari SO, Getrajdman GI, Petre EN, Sofocleous CT, Siegelbaum RH, Erinjeri JP, Weiser MR, Thornton RH. Safety and efficacy of percutaneous cecostomy/colostomy for treatment of large bowel obstruction in adults with cancer. J Vasc Interv Radiol 2014; 26:182-8. [PMID: 25529188 DOI: 10.1016/j.jvir.2014.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To assess the safety and efficacy of image-guided percutaneous cecostomy/colostomy (PC) in the management of colonic obstruction in patients with cancer. MATERIALS AND METHODS Twenty-seven consecutive patients underwent image-guided PC to relieve large bowel obstruction at a single institution between 2000 and 2012. Colonic obstruction was the common indication. Patient demographics, diagnosis, procedural details, and outcomes including maximum colonic distension (MCD; ie, greatest transverse measurement of the colon on radiograph or scout computed tomography image) were recorded and retrospectively analyzed. RESULTS Following PC, no patient experienced colonic perforation; pain was relieved in 24 of 27 patients (89%). Catheters with tip position in luminal gas rather than mixed stool/gas or stool were associated with greater decrease in MCD (-40%, -12%, and -16%, respectively), with the difference reaching statistical significance (P = .002 and P = .013, respectively). Catheter size was not associated with change in MCD (P = .978). Catheters were successfully removed from six of nine patients (67%) with functional obstructions and two of 18 patients (11%) with mechanical obstructions. One patient underwent endoscopic stent placement after catheter removal. Three patients required diverting colostomy after PC, and their catheters were removed at the time of surgery. One major complication (3.7%; subcutaneous emphysema, pneumomediastinum, and sepsis) occurred 8 days after PC and was successfully treated with cecostomy exchange, soft-tissue drainage, and intravenous antibiotic therapy. CONCLUSIONS Image-guided PC is safe and effective for management of functional and mechanical bowel obstruction in patients with cancer. For optimal efficacy, catheters should terminate within luminal gas.
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Affiliation(s)
- Sanjit O Tewari
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - George I Getrajdman
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Constantinos T Sofocleous
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert H Siegelbaum
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph P Erinjeri
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Raymond H Thornton
- Department of Radiology, Section of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Sahoo MR, Kumar A, Jaiswal S, C B. Transverse colon perforation due to carcinoma rectum: an unusual presentation against Laplace's law. BMJ Case Rep 2013; 2013:bcr-2013-008561. [PMID: 23955978 DOI: 10.1136/bcr-2013-008561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of distal large bowel obstruction, in the setting of a competent ileocaecal valve, the caecum is the most common site of perforation (for Laplace's law). We describe a case of obstruction at the rectum due to constricting carcinomatous growth, presenting with perforation of transverse colon (against Laplace's law). A 60-year-old women presented to the emergency department with acute abdominal pain. The pain was preceded by 3 days of intestinal obstruction. Clinically there was guarding and rigidity. Straight X-ray of the abdomen revealed free gas under diaphragm. Surgical exploration revealed transverse colon perforation with carcinoma of rectum. Loop transverse colostomy was performed as the patient was very sick. The patient improved slowly in the intensive care unit. To conclude, even though the caecum is the most common site for perforation in case of distal obstruction, perforation of transverse colon can occur otherwise as a unique presentation.
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Yahng SA, Yoon JH, Shin SH, Lee SE, Eom KS, Kim YJ. Acute colonic pseudo-obstruction following allogeneic stem cell transplantation successfully treated by neostigmine. Blood Res 2013; 48:145-8. [PMID: 23826585 PMCID: PMC3698401 DOI: 10.5045/br.2013.48.2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 04/27/2012] [Accepted: 05/30/2013] [Indexed: 11/17/2022] Open
Abstract
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a rare clinical syndrome of massive large bowel dilatation without mechanical obstruction, which may cause significant morbidity and mortality. Treatment focuses on decompressing a severely dilated colon. The proposed theory that this severe ileus results from an imbalance in the autonomous regulation of colonic movement supports the rationale for using neostigmine, a reversible acetylcholinesterase inhibitor, in patients who failed conservative care. Although gastrointestinal complications are frequent following allogeneic stem cell transplantation (SCT), the incidence of ACPO in a transplant setting is unknown and, if not vigilant, this adynamic ileus can be underestimated. We describe the case of a patient with myelodysplastic syndrome undergoing non-myeloablative allogeneic SCT from a partially human leukocyte antigen-mismatched sibling donor, and whose clinical course was complicated by ACPO in the early post-engraftment period. The ileus was not associated with gut graft-versus-host disease or infectious colitis. After 3 days of conservative care, intravenous neostigmine (2 mg/day) was administered for 3 consecutive days. Symptoms and radiologic findings began to improve 72 hours after the initial injection of neostigmine, and complete response without any associated complications was achieved within a week. Thus, neostigmine can be a safe medical therapy with successful outcome for patients who develop ACPO following allogeneic SCT.
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Affiliation(s)
- Seung-Ah Yahng
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
We report Ogilvie's syndrome following posterior spinal arthrodesis on a patient with thoracic and lumbar scoliosis associated with intraspinal anomalies. Postoperative paralytic ileus can commonly complicate scoliosis surgery. Ogilvie's syndrome as a cause of abdominal distension and pain has not been reported following spinal deformity correction and can mimic post-surgical ileus. 12 year old female patient with double thoracic and lumbar scoliosis associated with Arnold-Chiari 1 malformation and syringomyelia. The patient underwent posterior spinal fusion from T4 to L3 with segmental pedicle screw instrumentation and autogenous iliac crest grafting. She developed abdominal distension and pain postoperatively and this deteriorated despite conservative management. Repeat ultrasounds and abdominal computer tomography scans ruled out mechanical obstruction. The clinical presentation and blood parameters excluded toxic megacolon and cecal volvulus. As the symptoms persisted, a laparotomy was performed on postoperative day 16, which demonstrated ragged tears of the colon and cecum. A right hemi-colectomy followed by ileocecal anastomosis was required. The pathological examination of surgical specimens excluded inflammatory bowel disease and vascular abnormalities. The patient made a good recovery following bowel surgery and at latest followup 3.2 years later she had no abdominal complaints and an excellent scoliosis correction. Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after scoliosis correction. Early diagnosis and instigation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.
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Affiliation(s)
- Athanasios I Tsirikos
- Consultant Orthopaedic and Spine Surgeon, Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh, EH9 1LF, UK,Address for correspondence: Mr. Athanasios I. Tsirikos, Consultant Orthopaedic and Spine Surgeon, Honorary Clinical Senior Lecturer-University of Edinburgh, Scottish National Spine Deformity Center, Sciennes Road, Edinburgh, EH9 1LF, UK. E-mail:
| | - Alok Sud
- Commonwealth Travelling Spinal Fellow, Scottish National Spine Deformity Center, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF, UK
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Colonoscopy is superior to neostigmine in the treatment of Ogilvie's syndrome. Am J Surg 2012; 204:849-55; discussion 855. [DOI: 10.1016/j.amjsurg.2012.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/07/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022]
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Multimodality imaging of cecal bascule: report of a case following pelvic surgery. Clin J Gastroenterol 2012; 5:225-9. [DOI: 10.1007/s12328-012-0306-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 04/17/2012] [Indexed: 12/30/2022]
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Than KD, Wang AC, Rahman SU, Wilson TJ, Valdivia JM, Park P, La Marca F. Complication avoidance and management in anterior lumbar interbody fusion. Neurosurg Focus 2011; 31:E6. [DOI: 10.3171/2011.7.focus11141] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough review of databases from the US National Library of Medicine and the National Institutes of Health was conducted. The complications of ALIF addressed in this paper include pseudarthrosis and subsidence, vascular injury, retrograde ejaculation, ileus, and lymphocele (chyloretroperitoneum). Strategies identified for improving fusion rates included the use of frozen rather than freeze-dried allograft, cage instrumentation, and bone morphogenetic protein. Lower cage heights appear to reduce the risk of subsidence. The most common vascular injury is venous laceration, which occurs less frequently when using nonthreaded interbody grafts such as iliac crest autograft or femoral ring allograft. Left iliac artery thrombosis is the most common arterial injury, and its occurrence can be minimized by intermittent release of retraction intraoperatively. The risk of retrograde ejaculation is significantly higher with laparoscopic approaches, and thus should be avoided in male patients. Despite precautionary measures, complications from ALIF may occur, but treatment options do exist. Bowel obstruction can be treated conservatively with neostigmine or with decompression. In cases of postoperative lymphocele, resolution can be attained by creating a peritoneal window. By recognizing ways to minimize complications, the spine surgeon can safely use ALIF procedures.
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Abstract
Bowel obstruction and abdominal hernia are commonly observed in patients seeking emergency care for abdominal pain. This article discusses bowel obstruction, adynamic ileus, acute colonic pseudo-obstruction, and abdominal hernias, with particular emphasis on the management of patients in the emergency department (ED). Although the diagnostic approach to bowel obstruction often requires imaging, abdominal hernia may be identified in most circumstances by history and physical examination alone. Urgent surgical consultation is indicated when there is a concern for bowel ischemia, strangulation, or complete obstruction. This article reviews an ED-based approach to the patient presenting with symptoms of bowel obstruction or hernia.
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Affiliation(s)
- Geoffrey E Hayden
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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33
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Cooney DR, Cooney NL. Massive acute colonic pseudo-obstruction successfully managed with conservative therapy in a patient with cerebral palsy. Int J Emerg Med 2011; 4:15. [PMID: 21559070 PMCID: PMC3084169 DOI: 10.1186/1865-1380-4-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 04/14/2011] [Indexed: 12/26/2022] Open
Abstract
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a massive dilation of the colon in the absence of mechanical obstruction. Treatment measures may include anticholinergic agents such as neostigmine, colonoscopy, or fluoroscopic decompression, surgical decompression, and partial or complete colectomy. We reviewed the case of a 26-year-old male with cerebral palsy who had a history of chronic intermittent constipation who presented to the emergency department (ED) with signs of impaction despite recurrent fleet enemas and oral polyethylene glycol 3350. The patient was found to have a massive colonic distention of 26 cm likely because of bowel dysmotility, consistent with ACPO. This article includes a discussion of the literature and images that represent clinical examination, x-ray, and computed tomography (CT) findings of this patient, who successfully underwent conservative management only. Emergency department detection of this condition is important, and early intervention may prevent surgical intervention and associated complications.
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Affiliation(s)
- Derek R Cooney
- Department of Emergency Medicine, SUNY Upstate Medical University, EMSTAT Center/550 East Genesee, Syracuse, New York 13202, USA
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34
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Rosenblat JM, Rozenblit AM, Wolf EL, DuBrow RA, Den EI, Levsky JM. Findings of Cecal Volvulus at CT. Radiology 2010; 256:169-75. [DOI: 10.1148/radiol.10092112] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Harrison ME, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI, Ikenberry SO, Jain R, Khan K, Krinsky ML, Maple JT, Shen B, Van Guilder T, Baron TH, Dominitz JA. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71:669-79. [PMID: 20363408 DOI: 10.1016/j.gie.2009.11.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 02/06/2023]
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Abstract
Patients presenting with general surgical emergencies are hypovolemic, and require early aggressive resuscitative efforts. Although these efforts may safely be accomplished preoperatively in a select subset of patients, it is often the combined task of surgeons, anesthesiologists, and internists to optimize these critically ill patients in the intraoperative and postoperative period. Early surgical consultation and intervention can be lifesaving. This article presents the current state of emergency surgical care in the United States and the approach to the patient with an emergency surgical illness. The aggressiveness of the surgical intervention is patient- and disease-specific and requires frequent and open communication between all health care providers, the patient, and his or her family. In addition to aggressive resuscitation, life-threatening general surgical conditions often require specific diagnostic and therapeutic interventions.
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Affiliation(s)
- Kevin M Schuster
- Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University, School of Medicine, 330 Cedar Street, BB 310, New Haven, CT 06520, USA.
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37
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Abstract
Patients presenting with general surgical emergencies are hypovolemic, and require early aggressive resuscitative efforts. Although these efforts may safely be accomplished preoperatively in a select subset of patients, it is often the combined task of surgeons, anesthesiologists, and internists to optimize these critically ill patients in the intraoperative and postoperative period. Early surgical consultation and intervention can be lifesaving. This article presents the current state of emergency surgical care in the United States and the approach to the patient with an emergency surgical illness. The aggressiveness of the surgical intervention is patient- and disease-specific and requires frequent and open communication between all health care providers, the patient, and his or her family. In addition to aggressive resuscitation, life-threatening general surgical conditions often require specific diagnostic and therapeutic interventions.
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Affiliation(s)
- Kevin M Schuster
- Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University, School of Medicine, BB 310, New Haven, CT 06520, USA.
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38
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Abstract
AbstractBackgroundAcute colonic pseudo-obstruction is characterized by clinical and radiological evidence of acute large bowel obstruction in the absence of a mechanical cause. The condition usually affects elderly people with underlying co-morbidities, and early recognition and appropriate management are essential to reduce the occurrence of life-threatening complications.MethodsA part-systematic review was conducted. This was based on key publications focusing on advances in management.Results and conclusionsAlthough acute colonic dilatation has been suggested to result from a functional imbalance in autonomic nerve supply, there is little direct evidence for this. Other aetiologies derived from the evolving field of neurogastroenterology remain underexplored. The rationale of treatment is to achieve prompt and effective colonic decompression. Initial management includes supportive interventions that may be followed by pharmacological therapy. Controlled clinical trials have shown that the acetylcholinesterase inhibitor neostigmine is an effective treatment with initial response rates of 60–90 per cent; other drugs for use in this area are in evolution. Colonoscopic decompression is successful in approximately 80 per cent of patients, with other minimally invasive strategies continuing to be developed. Surgery has thus become largely limited to those in whom complications occur. A contemporary management algorithm is provided on this basis.
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Affiliation(s)
- R De Giorgio
- Department of Clinical Medicine and Centro Unificato di Ricerca BioMedica Applicata, University of Bologna, Bologna, Italy
| | - C H Knowles
- Centre for Academic Surgery, Royal London Hospital, London, UK
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McNamara R, Mihalakis MJ. Acute colonic pseudo-obstruction: rapid correction with neostigmine in the emergency department. J Emerg Med 2008; 35:167-70. [PMID: 18242923 DOI: 10.1016/j.jemermed.2007.06.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2007] [Accepted: 06/12/2007] [Indexed: 11/30/2022]
Abstract
Ogilvie's syndrome, now known as acute colonic pseudo-obstruction, is characterized by massive dilatation of large bowel in the absence of mechanical obstruction. It is found in a variety of patients, although elderly and immobile patients make up a large portion of the afflicted population. This article discusses the case of a 64-year-old bedridden, paraplegic, male nursing home resident who presented to the Emergency Department with a chronic history of abdominal distention that acutely worsened on the day of his arrival. A diagnosis of acute colonic pseudo-obstruction was made and 2 mg of intravenous neostigmine was administered, with resolution of the patient's condition allowing for subsequent Emergency Department discharge. This report discusses the utilization of neostigmine, an acetylcholinesterase inhibitor, for patients with colonic pseudo-obstruction. We also briefly review the literature on this condition and other therapeutic options.
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Affiliation(s)
- Robert McNamara
- Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA
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Slam KD, Calkins S, Cason FD. LaPlace's law revisited: cecal perforation as an unusual presentation of pancreatic carcinoma. World J Surg Oncol 2007; 5:14. [PMID: 17274817 PMCID: PMC1802866 DOI: 10.1186/1477-7819-5-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 02/02/2007] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pancreatic cancer is often locally and distally aggressive, but initial presentation as cecal perforation is uncommon. CASE PRESENTATION We describe a patient presenting with pneumoperitoneum, found at initial exploration to have a cecal perforation believed to be secondary to a large cecal adenoma, after palpation of the remainder of the colon revealed hard stool but no distal obstruction. Postoperatively, however, the patient progressed to large bowel obstruction and upon reexploration, a mass could now be delineated, encompassing the splenic flexure, splenic hilum, and distal pancreas. Histological evaluation determined this was locally invasive pancreatic adenocarcinoma, and therefore the true etiology of the original cecal perforation. CONCLUSION Any perforation localized to the cecum must be highly suspicious for a distal obstruction, as dictated by the law of LaPlace.
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Affiliation(s)
- Kristine D Slam
- Department of Surgery, University of Toledo, Health Sciences Campus, 3065 Arlington Avenue, Dowling Hall, Toledo, Ohio 43614 USA
| | - Sarah Calkins
- Department of Surgery, University of Toledo, Health Sciences Campus, 3065 Arlington Avenue, Dowling Hall, Toledo, Ohio 43614 USA
| | - Frederick D Cason
- Department of Surgery, University of Toledo, Health Sciences Campus, 3065 Arlington Avenue, Dowling Hall, Toledo, Ohio 43614 USA
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Kakarla A, Posnett H, Jain A, Ash A. Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following instrumental vaginal delivery. Int J Clin Pract 2006; 60:1303-5. [PMID: 16981974 DOI: 10.1111/j.1742-1241.2005.00740.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute pseudo-obstruction of the colon (Ogilvie's syndrome) is an adynamic ileus without mechanical obstruction of the bowel. Predisposing factors include: abdominal and pelvic surgery, or trauma, or severe pre-existing systemic illness. In obstetrics, many cases have been reported after caesarean delivery, but none following a vaginal delivery. Conservative and pharmacological therapies are effective in many patients, but surgical intervention may be required. Early diagnosis and appropriate treatment is imperative to avoid caecal rupture, faecal peritonitis and the associated high maternal mortality. High index of clinical suspicion and proper assessment of the gastrointestinal system in the post-surgical patient are vital to the management of this uncommon but potentially serious condition met with in obstetrics practice.
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Affiliation(s)
- A Kakarla
- Department of Obstetrics and Gynaecology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
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42
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Colucci G, Thaler W, Dejaco H, Marsoner H, Grones A. Colonic Rupture in a Patient on Combination Chemotherapy for Metastasized Carcinoma of the Esophagogastric Junction. Case Report and Review of the Literature. Oncol Res Treat 2005; 28:204-6. [PMID: 15840969 DOI: 10.1159/000084143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cecal perforation due to neutropenic colitis is a known and described side effect of many chemotherapy regimens. We present a case of a patient with gastric adenocarcinoma who developed spontaneous cecal perforation during chemotherapy without the classic pattern of typhlitis. CASE REPORT A 58-year-old woman was on chemotherapy for an adenocarcinoma of the gastric junction, when she developed a cecal perforation. There was neither evidence for leucopenia nor for typhlitis. Laparotomy was performed and cecostomy was established using the perforated bowel. Postoperative course was uneventful. The patient died from tumor progression 8 months after the diagnosis was made. CONCLUSION There is no evidence for a connection between this event and chemotherapy treatment but neither can it be excluded. Even if unusual, colon toxicity could be a potential life-threatening complication associated with more drugs than usually thought.
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Affiliation(s)
- Gianluca Colucci
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico G. B. Rossi, Verona, Italy
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43
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Abstract
Acute colonic pseudoobstruction (ACPO) is a clinical condition of acute large bowel obstruction without mechanical blockage. ACPO occurs most often in hospitalized patients with serious underlying medical and surgical conditions. ACPO is an important cause of morbidity and mortality. The pathogenesis of ACPO is not completely understood but likely results from an imbalance in the autonomic regulation of colonic motor function. Metabolic or pharmacologic factors, as well as spinal or retroperitoneal trauma, may alter the autonomic regulation of colonic function, leading to excessive parasympathetic suppression or sympathetic stimulation. This imbalance results in colonic atony and pseudoobstruction. Early recognition and appropriate management are critical to minimizing morbidity and mortality. The mortality rate is estimated at 40% when ischemia or perforation occurs. The best documented treatment of ACPO is intravenous neostigmine, which leads to prompt decompression in the majority of patients after a single infusion. In patients failing or having contraindications to neostigmine, colonoscopic decompression is the active intervention of choice. Surgery is reserved for those with overt peritonitis or perforation.
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Affiliation(s)
- Michael D Saunders
- Division of Gastroenterology, University of Washington Medical Center, 1959 NE Pacific Avenue, Box 356424, Seattle, WA 98195, USA.
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44
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Suri S, Hillman K. Neostigmine for treatment of acute colonic pseudo-obstruction. Indian J Crit Care Med 2005. [DOI: 10.4103/0972-5229.17094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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45
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Hamilton SW, Jabbar AA. Ogilvie's syndrome: a rare complication of inguinal hernia repair. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2004; 65:562-3. [PMID: 15449496 DOI: 10.12968/hosp.2004.65.9.15989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A 49-year-old man had an open, tension-free, mesh (Lichtenstein) repair performed under general anaesthetic for a left-sided direct inguinal hernia. His immediate postoperative recovery was uneventful and he was discharged the following day. He was readmitted as an emergency 2 days later with intermittent abdominal pain, nausea and complete constipation. On examination his abdomen was slightly distended, but was not tender. X-ray (Figure 1) showed dilated loops of small bowel with gas in the colon and rectum. He was managed conservatively. However, over the next 24 hours his symptoms became worse with increasing abdominal pain and vomiting. He was still passing no flatus. His abdomen became more distended and generally tender to light palpation. Repeat X-ray (Figure 2) revealed markedly distended small bowel and a grossly distended caecum. He proceeded to theatre as the caecal distension was increasing and he had developed signs of peritoneal irritation. At laparotomy his bowel was free from the left hernia repair and no mechanical cause for the obstruction was found. The colon was distended to the rectum and the caecum was 10 cm in diameter with tearing almost imminent. It was therefore decompressed with an aspiration needle and on-table sigmoidoscopy. Appendicectomy was performed and the stump used to place a caecostomy. Recovery was slow but he was discharged home 2 weeks after readmission.
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Affiliation(s)
- S W Hamilton
- Department of Orthopaedic Surgery, Aberdeen Royal Infirmary, Aberdeen
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46
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Abstract
The gastroenterologist is frequently involved in the care of patients with bowel obstruction and pseudo-obstruction. In the case of obstruction, the central problem is determining which patients should be managed surgically. In both SBO and LBO, evidence of vascular compromise to the gut mandates surgical intervention. Most patients with pseudo-obstruction respond to conservative therapy or neostigmine. Endoscopic decompression is indicated in recalcitrant cases, with surgery reserved as a last resort.
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Affiliation(s)
- Charles J Kahi
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202-5121, USA
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47
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Abstract
Intestinal pseudo-obstruction is defined as a clinical syndrome characterized by impairment of intestinal propulsion, which may resemble intestinal obstruction, in the absence of a mechanical cause. It may involve the small and/or the large bowel, and may present in acute, subacute or chronic forms. We have performed a systematic review of acute pseudo-obstruction, also referred to as Ogilvie's syndrome in the literature, and focused on proposed mechanisms, manifestations and management of post-surgery and critically ill patients who suffer from one or more underlying clinical conditions. The hallmark of the syndrome is massive intestinal distension, which is detected on clinical inspection and plain abdominal radiography. The underlying pathophysiological mechanisms are not fully understood. Therefore, treatment focuses on preventing intestinal perforation, which is associated with an average 21% mortality rate.
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Affiliation(s)
- Silvia Delgado-Aros
- Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic, 200 First Street SW, Charlton 8-110, Rochester, MN 55905, USA
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48
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Abstract
Intestinal pseudo-obstruction is defined as a clinical syndrome characterized by impairment of intestinal propulsion, which may resemble intestinal obstruction, in the absence of a mechanical cause. It may involve the small and/or the large bowel, and may present in acute, subacute or chronic forms. We have performed a systematic review of acute pseudo-obstruction, also referred to as Ogilvie's syndrome in the literature, and focused on proposed mechanisms, manifestations and management of post-surgery and critically ill patients who suffer from one or more underlying clinical conditions. The hallmark of the syndrome is massive intestinal distension, which is detected on clinical inspection and plain abdominal radiography. The underlying pathophysiological mechanisms are not fully understood. Therefore, treatment focuses on preventing intestinal perforation, which is associated with an average 21% mortality rate.
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Affiliation(s)
- Silvia Delgado-Aros
- Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Mayo Clinic, 200 First Street SW, Charlton 8-110, Rochester, MN 55905, USA
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49
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Delgado-Aros S, Camilleri M. Manejo clínico de la seudoobstrucción aguda de colon en el enfermo hospitalizado: revisión sistemática de la bibliografía. GASTROENTEROLOGIA Y HEPATOLOGIA 2003; 26:646-55. [PMID: 14670240 DOI: 10.1016/s0210-5705(03)70426-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intestinal pseudoobstruction is a clinical syndrome characterized by impairment of intestinal propulsion, which may resemble intestinal obstruction, in the absence of a mechanical cause. It usually affects the colon but the small intestine may also be involved, and may present in acute, subacute or chronic forms. We have performed a systematic review of the acute form of pseudoobstruction, also referred to as Ogilvie's syndrome. We discuss proposed pathophysiological mechanisms, manifestations and management of this clinical condition in post-surgery and critically ill patients. The hallmark of the syndrome is massive intestinal distension, which is detected on clinical inspection and plain abdominal radiography. The underlying pathophysiological mechanisms are not fully understood. Therefore, treatment has focussed on preventing intestinal perforation, which is associated with a 21% mortality rate.
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Affiliation(s)
- S Delgado-Aros
- Clinical Enteric Neuroscience Translational & Epidemiological Research (CENTER) Program. Mayo Clinic. Rochester. United States.
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50
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Gluecker TM, Williamson EE, Fletcher JG, Hough DM, Huppert BJ, Carlson SK, Casey MB, Farrell MA. Diseases of the cecum: a CT pictorial review. Eur Radiol 2002; 13 Suppl 6:L51-61. [PMID: 16440231 DOI: 10.1007/s00330-002-1777-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2002] [Revised: 10/11/2002] [Accepted: 11/12/2002] [Indexed: 12/18/2022]
Abstract
Cecal pathology is commonly encountered and may represent a diagnostic challenge in patients with either acute or chronic clinical presentations. Although appendicitis accounts for the majority of surgical conditions presenting with right lower quadrant pain, readers should be aware of the broad spectrum of cecal pathologies and characteristic CT findings, which can be useful in establishing the correct diagnosis.
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