Acute colonic pseudo-obstruction (Ogilvie's syndrome).

Acute colonic dilation without mechanical obstruction (Ogilvie's syndrome) was first described in 1948. The pathogenesis remains unknown but likely involves imbalance between sympathetic and parasympathetic colonic innervation. Patients are generally hospitalized with another serious illness when the syndrome develops. There are no controlled data on the efficacy of any therapy. A trial of conservative measures alone is appropriate in a subset of patients who lack significant abdominal pain, peritoneal findings, and who have one or more potential underlying factors that are reversible. Colonoscopy is the initial invasive therapeutic maneuver but fails in 31% of patients and is followed by recurrence in 40% of those in whom initial decompression is successful. Placement of a tube during colonoscopy may help to prevent recurrence. No pharmacological therapy is proven effective, although anecdotal successes with some agents suggest clinical trials that should be performed. A minority of patients still require surgical cecostomy, which has been recently performed via laparoscopy.