Vanek and Al-Salti identified factors affecting the outcome of a patient with acute Ogilvie's syndrome (pseudo-obstruction of the colon). These can help to identify a patient who may require more aggressive management. The authors are from St. Elizabeth Hospital Medical Center in Youngstown, Ohio.



(1) cecal diameter in cm

(2) time to decompression


Criteria for decompression - at least 1 of the following:

(1) cecal diameter > 12 cm

(2) failure to improve with conservative management at 72 hours


Risk factors for mortality:

(1) cecal diameter > 14 cm

(2) time to decompression > 7 days

(3) bowel rupture

(4) debilitation and/or severe comorbidity



(1) Colonoscopy is effective for decompression if done carefully.

(2) A tube cecostomy is effective if colonoscopy fails or if there is a small bowel perforation.

(3) If the bowel is ischemic or has perforated, then colonic resection with or without anastomosis is required.


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