Acute pseudo-obstruction of the colon is the massive dilatation of the colon without evidence of mechanical obstruction. When acute pseudo-obstruction occurs without evidence of colonic disease, it is known as Ogilvie's syndrome, and occurs as a complication of an underlying clinical condition. if perforation, usually of the cecum, occurs, the mortality rate can be as high as 50%.
Patients with acute colonic pseudo-obstruction are usually postoperative or critically ill. The numerous conditions associated with pseudo-obstruction include recent surgery, trauma, metabolic disturbances, electrolyte imbalance, sepsis, infections, narcotics and other medications, hypothyroidism, diabetes, renal failure, myocardial infarction, inflammatory processes, and prolonged bed rest. It is more predominant in males and is most commonly reported in the sixth decade of life. It is almost always temporary and reversible. Acute pseudo-obstruction is believed to result from an imbalance between neurotransmitters of the sympathetic and the parasympathetic neurons.
Patients with acute pseudo-obstruction have a soft, but distended, and tympanic abdomen. Bowel sounds are high pitched to absent. Patients usually do not have peritoneal signs or colicky pain, but may precipitate vague abdominal pain as the cecum distends. Nausea and vomiting may be present. Patients may pass flatus and liquid stools or they may be obstipated. White blood cell (WBC) count is usually normal.
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