TREATMENT OF THE DYNAMIC ILEUS OF THE COL ON (OGILVIES-SYNDROME) WITHCISAPRIDE

A case is reported of a 68-year-old woman admitted in the ICU for acut e exacerbation of a chronic obstructive respiratory disease. The trach ea was intubated and the lungs ventilated mechanically. She received s edation including midazolam and phenoperidine 1 mg . h-1. On the 6th d ay, she experienced a massive colonic dilation (caecal diameter of 10 cm at X-ray examination). A colonoscopy was performed which showed the absence of obstruction, confirmed the diagnosis of pseudo-obstruction of the colon and allowed a decompression which was unefficient. A new colonoscopic decompression was performed on the 8th day, without prol onged effect. At that time, the patient was given cisapride in her gas tric tube (80 mg). This treatment restarted the bowel movements within 48 hours and the caecal diameter decreased immediately to 7 cm. Cisap ride was maintained for 10 days and mechanical ventilation for 30 days . No further dilation occurred during this time and the patient was di scharged from the ICU. Few cases of Olgivie's syndrome successfully tr eated with cisapride have been reported in the literature. The efficac y of this agent for the treatment of Ogilvie's syndrome remains to be assessed in a controlled study.