Maloney and Vargas proposed an algorithm for managing a patient with acute colonic pseudo-obstruction (Ogilvie's Syndrome). The authors are from Eastern Virginia Medical School and Tidewater Surgical Specialists in Virginia.


Patient selection: acute colonic pseudo-obstruction

Initial Assessment


peritoneal signs or other evidence of colonic perforation


positive response to conservative management

confirm resolution and monitor for recurrence

failure of conservative therapy within 24 or 48 hours

prokinetic drug administration OR decompression by colonoscopy OR cecostomy


Conservative management steps:

(1) nothing by mouth (NPO)

(2) insert nasogastric tube

(3) insert rectal flatus tube

(4) adjust posture and ambulate if possible

(5) correct any electrolyte imbalance

(6) correct any predisposing cause

(7) stop or change contributory drugs (opioids, anticholinergics, etc)


Patients who may not be candidates for intravenous neostignmine as prokinetic drug:

(1) bradycardia

(2) low systolic blood pressure

(3) renal insufficiency

(4) bronchospasm

(5) bowel ischemia, perforation or obstruction

(6) uncontrolled cardiac arrhythmias

(7) inability to provide cardiac monitoring during administration


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