Features suggesting acute colonic obstruction:
(1) signs and symptoms with
(1a) abdominal distention
(1b) variable abdominal pain
(1c) nausea and vomiting
(1d) constipation
(2) imaging studies showing a dilated colon, which may be limited to the right colon or involve the entire colon
About half of patients with Ogilvie's syndrome will continue to pass flatus, which is not seen in true obstruction.
Diagnosis requires exclusion of a mechanical obstruction.
The condition occurs when there is an imbalance in the autonomic stimulation of the bowel, resulting in muscle atony and dilatation. This imbalance may occur as a result of:
(1) spinal or other trauma
(2) medications
(3) metabolic imbalance, including renal failure
(4) following surgery, including Cesarean section
(5) infection
(6) cardiac disease
The syndrome may range from mild to severe.
In severe cases there may be cecal rupture with peritonitis. The cecal rupture occurs due to a combination of ischemia (due to poor perfusion through compressed arteries), elevated intra-luminal pressure and limited wall strength.
