Management of Acute Colonic Pseudo-Obstruction

Acute colonic pseudo-obstruction (ACPO), or Ogilvie’s syndrome, is characterised by massive dilatation of the colon in the absence of a mechanical blockage. It typically arises in the context of recent surgery, severe illness or pharmacological influences that disrupt autonomic regulation of gut motility. Initial management revolves around careful patient assessment, correction of electrolyte imbalances, cessation of offending medications and maintenance of adequate hydration. Conservative measures include bowel rest, nasogastric decompression and ambulation. In patients who fail to respond or who develop signs of ischaemia or impending perforation, pharmacological stimulation of motility with acetylcholinesterase inhibitors such as neostigmine may be instituted under cardiac monitoring. Endoscopic decompression provides a minimally invasive option for refractory cases, while surgical intervention—usually in the form of diversion or resection—is reserved for ischaemic or perforated bowel. A multidisciplinary approach, involving surgeons, gastroenterologists and critical care teams, is essential to tailor therapy to individual risk profiles and to prevent life-threatening complications.

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Management of Acute Colonic Pseudo-Obstruction publication trend

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Technical terms

Acute colonic pseudo-obstruction (ACPO): functional dilatation of the colon without mechanical blockage, often seen postoperatively or in critical illness, with potential for ischaemia and perforation.

Endoscopic decompression: use of a colonoscope to relieve colonic distension by aspirating gas and fluid, thereby reducing intraluminal pressure.

Neostigmine: an acetylcholinesterase inhibitor administered intravenously to enhance colonic motility in patients unresponsive to conservative measures.

Ischaemia: tissue injury resulting from inadequate blood supply, which in the colon can lead to mucosal necrosis and perforation if not promptly corrected.

References

1. Acute Colonic Pseudo-Obstruction: A Case of Ogilvie Syndrome. Cureus (2024).
2. Ogilvie Syndrome and Acute Kidney Injury: A Rare Complication of Cesarean Section and Preeclampsia. Journal of Clinical Medicine (2023).
3. Fatal Ogilvie’s syndrome after hip surgery and review of the literature. Forensic Science, Medicine and Pathology (2022).