ogilvies syndrome
TRANSCRIPT
1
OGILVIE’S SYNDROME
DR.SOBIA AKRAM KHAWAJA,
MBBS,FCPS,MRCS
DEPARTMENT OF SURGERY
INTERNATIONAL MEDICAL CENTRE
21st NOVEMBER 2012
11/21/2012
2
DEFINITION:
• Ogilvie syndrome is the acute pseudo obstruction and dilation of the colon in the absence of any mechanical obstruction in severely ill patients
11/21/2012
3
CHARECTARISTICS
• Colonic pseudo-obstruction is characterized by massive dilatation of the cecum (diameter > 10 cm) and right colon on abdominal X-ray.
• It is a type of megacolon, sometimes referred to as "acute megacolon," to distinguish it from toxic megacolon.
11/21/2012
4
BACKGROUND
The condition carries the
name of the British surgeon
Sir William Heneage Ogilvie
(1887–1971), who first
reported it in 1948
11/21/2012
5
ETIOLOGYAFTER SURGERY
11/21/2012
6
ETIOLOGYBEDRIDDEN
11/21/2012
7
ETIOLOGY
NEUROLOGICAL DISORDERSCARDIO RESPIRATORY INSUFFICIENCY
11/21/2012
8
ETIOLOGYMETABOLIC DISTURBANCES
11/21/2012
9
ETIOLOGY
SEVERE CONSTIPATION
11/21/2012
10
ETIOLOGY
MALIGNANCY
11/21/2012
11
ETIOLOGY
SYSTEMIC INFECTION
11/21/2012
12
ETIOLOGY
DRUGS THAT DISTURB COLONIC MOTILITY (e.g.,anticholinergics or opioid analgesics)
11/21/2012
13
PATHOPHYSIOLOGY
• The exact mechanism behind the acute colonic pseudo-obstruction is not known.
• The probable explanation is imbalance in the regulation of colonic motor activity by the autonomic nervous system
11/21/2012
1411/21/2012
15
PATHOPHYSIOLOGY
• Acute megacolon develops because of abnormal intestinal motility.
11/21/2012
16
PATHOPHYSIOLOGY
• Acute megacolon can also lead to ischemic necrosis in massively dilated intestinal segments. This is explained by Pascal's principle and Laplaces's law
11/21/2012
17
EPEDEMIOLOGY
• FREQUENCY• RACE• SEX• AGE
11/21/2012
18
SIGNS AND SYMPTOMSABDOMINAL DISTENSION
ABDOMINAL PAIN
11/21/2012
19
SIGNS AND SYMPTOMS
ALTERED BOWEL MOVEMENTS NAUSEA AND VOMITING
11/21/2012
20
SIGNS AND SYMPTOMS
FEVER
11/21/2012
21
DIFFERENTIAL DIAGNOSIS
• MESENTERIC ISCHEMIA• COLON CANCER• COLONIC OBSTRUCTION• CONSTIPATION• DIVERTICULITIS• HIRSCHPRUNGS
DISEASE• MEGACOLON• PSEUDOMEMBRANOUS
COLITIS• INTESTINAL
PERFORATION
11/21/2012
22
COMPLICATIONS
Ogilvie's syndrome may precipitate :
Volvulus.
Perforation
11/21/2012
23
INVESTIGATIONS ABDOMINAL X-RAY MISCELLANEOUS
11/21/2012
24
TREATMENT
• It usually resolves with conservative therapy stopping oral ingestions, i.e. nil per os and a nasogastric tube, but may require colonoscopic decompression which is successful in 70% of the cases.
11/21/2012
25
TREATMENT
• A study published in the New England Journal of Medicine showed that neostigmine is a potent pharmacological way of decompressing the colon.
11/21/2012
26
TREATMENT
• According to the American Society for Gastrointestinal Endoscopy (ASGE), it should be considered prior to colonoscopic decompression.
• The use of neostigmine is not without risk since it can induce bradyarrhythmia and bronchospasms.
• Therefore atropine should be within immediate reach when this therapy is used
11/21/2012
27
TREATMENT
ENEMA THERAPY
11/21/2012
28
SURGICAL CARETUBE CECOSTOMY
11/21/2012
29
SURGICAL CARESUBTOTAL COLECTOMY
11/21/2012
30
FOLLOW UP
INPATIENT
CARE
11/21/2012
31
FOLLOW UP
OUT PATIENT
CARE
11/21/2012
32
PROGNOSIS
• It is a serious medical disorder and the mortality rate can be as high as 30%.
• Drug induced mega colon has been associated with mortality as high as 27.5%
11/21/2012
33
PATIENT EDUCATION
11/21/2012
3411/21/2012
3511/21/2012