Non-obstructive colonic dilatation ("Ogilvie's syndrome")

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by a bdominal distention and massive colonic dilatation without any mechanical c ause of obstruction. We have reviewed the records of 57 patients, 36 men an d 21 women (median age 65.4 y), from 1/1992 to 12/1996, with a colonic pseu do-obstruction, defined as dilatation of at least 10 cm on plain abdominal x-ray. 38 cases (66.5 %) followed surgery or trauma and 19 (33.5 %) develop ed symptoms during severe medical illness. 36 cases (63.2 %) got iv narcoti cs prior to development of Ogilvie's syndrome. 4 patients underwent conserv ative treatment alone, 53 patients (93 %) had endoscopic decompression with a decompression tube placed in 49 (86 %). Due to 2 failures and 2 complica tions of endoscopic treatment tone ischemic lesion, one perforation; compli cation rate 3.8 %) 4/53 patients had to be operated (7.5 %). Clinical succe ss of endoscopic treatment was 88.6 % at first attempt and 92.5 % at second attempt. General complications tended to be seven, according to the concom itant diseases (morbidity 35 %); overall hospital mortality was 21 % (12/57 ). In conclusion, we believe that endoscopic decompression and tube placeme nt is effective and safe for acute colonic pseudo-obstruction not respondin g to 24 hour conservative treatment.