Ogilvie syndrome as a postoperative complication

Hypothesis: Ogilvie syndrome is a postoperative complication. Design: Case series. Setting: University-affiliated tertiary-care hospital. Patients and Methods: The medical records of patients diagnosed as having O gilvie syndrome after trauma or operation between 1989 and 1998 were review ed. Medical charts were examined for history, treatment, cecal diameter, an d outcome. Main Outcome Measures: Data were summarized in an attempt to identify patie nt populations at risk for Ogilvie syndrome. Results: Ogilvie syndrome was diagnosed in 36 patients, 24 of whom were men . Average age at diagnosis was 68.9 years. Abdominal radiographs were obtai ned at time of diagnosis (mean cecal diameter, 13.4 cm; range, 8-20 cm). Op erations preceding Ogilvie syndrome were orthopedic or spinal (n=14), cardi othoracic (n=12), abdominal(n=5), and vascular (n=2). Nonoperative trauma a ccounted for 3 cases. Coronary artery bypass grafting was the single most f requent procedure leading to Ogilvie syndrome (n=9 [25%]). Conservative tre atment was successful in 52.8% of cases (n=19). Twenty colonoscopic decompr essions were performed on 13 patients, with an overall success rate of 77% (n=10). Of the 3 patients in whom colonoscopic decompression failed, 2 died and 1 required operation. Five of the 36 patients required surgical interv ention, with a mortality rate of 60% (n=3). Conclusions: Previous studies have shown Ogilvie syndrome to occur most com monly after obstetrical/gynecologic, abdominal/pelvic, and orthopedic proce dures. Our data confirm that patients undergoing orthopedic and spinal proc edures are at higher risk, but that the surgical procedure most commonly le ading to Ogilvie syndrome was coronary artery bypass grafting. Cardiothorac ic surgeons, orthopedic surgeons, and neurosurgeons should be cognizant of this complication in the patient whose abdomen becomes distended postoperat ively. If recognized early and treated appropriately, pseudo-obstruction wi ll resolve in most patients. If surgical intervention. is required, the sub sequent mortality rate is high.