1/24. Changing diagnostic and therapeutic approaches to the 'Ogilvie syndrome'.The only thing that has remained unchanged about the genuinely described 'Ogilvie syndrome' is its name. Recently it was considered to be an acute colonic pseudoobstruction, a clinical entity mimicking the mechanic ileus of the distal large intestine, without organic obstruction. It is almost always secondary to other diseases. Not all details of the pathogenesis are known, but it has become clear that the direct factor leading to the disturbance of the motility is a vegetative imbalance. X-ray findings are highly characteristic and critical in the planning of treatment. The danger for the patients is the progression of the state or the long duration of the process. Conservative treatment is suitable only for early cases, without complications. In case of failure non-invasive endoscopic or endoscopically assisted minimally invasive procedures may be mandatory. These methods have seen rapid advance in recent years. Uncertain diagnoses or complications call for open surgery. cecostomy is the solution of choice anyway. The mortality is high in this group of elderly polymorbid patients. Authors compare six of their cases with data collected from the literature.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
2/24. Ogilvie's syndrome after lower extremity arthroplasty.OBJECTIVE: To alert surgeons who perform arthroplasty to the possibility of acute colonic pseudo-obstruction (Ogilvie's syndrome) after elective orthopedic procedures. To identify possible risk factors and emphasize the need for prompt recognition, careful monitoring and appropriate management so as to reduce morbidity and mortality. DESIGN: A case series. SETTING: A university-affiliated hospital that is a major referral centre for orthopedic surgery. patients: Four patients who had Ogilvie's syndrome after lower extremity arthroplasty. Of this group, 2 had primary hip arthroplasty, 1 had primary knee arthroplasty and 1 had revision hip arthroplasty. MAIN OUTCOME MEASURES: morbidity and mortality. RESULTS: In all 4 patients Ogilvie's syndrome was recognized late and required surgical intervention. Two patients died as a result of postoperative complications. CONCLUSIONS: Our case series identified increasing age, immobility and patient-controlled narcotic analgesia as potential risk factors for Ogilvie's syndrome in the postoperative orthopedic patient. Prompt recognition and early consultation with frequent clinical and radiographic monitoring are necessary to avoid colonic perforation and its significant associated death rate.- - - - - - - - - - ranking = 2.0084255484465keywords = mortality, rate (Clic here for more details about this article) |
3/24. Colonic manifestations of multiple endocrine neoplasia type 2b: report of four cases.multiple endocrine neoplasia type 2b is best known for its endocrine manifestations and typical phenotype. The gastrointestinal manifestations, however, are also an important and commonly unrecognized component of the syndrome. We present four cases that demonstrate the varied presentation of patients with colonic manifestations of multiple endocrine neoplasia type 2b. We discuss the cause, diagnostic significance, and management of the colonic disease that is a component of multiple endocrine neoplasia type 2b.- - - - - - - - - - ranking = 0.0084255484465136keywords = rate (Clic here for more details about this article) |
4/24. Ogilvie's syndrome after cesarean delivery.Ogilvie's syndrome is a rare postsurgical complication that can be associated with cesarean delivery. It is characterized by massive dilation of the colon, much like that which occurs with an obstruction but in the absence of a mechanical obstruction. Early detection and intervention are necessary to avoid serious morbidity and/or mortality. Conservative treatment is effective in many cases, but surgical intervention may be required. nursing assessment of the gastrointestinal system in the postsurgical patient is reviewed using a case report of a patient who developed Ogilvie's syndrome after a cesarean delivery.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
5/24. Demonstration of varicella-zoster virus infection in the muscularis propria and myenteric plexi of the colon in an hiv-positive patient with herpes zoster and small bowel pseudo-obstruction (Ogilvie's syndrome).Gastrointestinal symptomatology as a complication of herpes zoster (HZ) is extremely rare, with the majority of reported cases showing only temporal or radiological evidence of GI tract involvement by varicella zoster virus (VZV) infection. We present the first case of documented direct VZV infection in the muscularis propria of the gut presenting as intestinal pseudo-obstruction (Ogilvie's syndrome). The patient was a 34-yr-old hiv man who developed small bowel pseudo-obstruction in association with disseminated cutaneous HZ. A partial ileocolectomy specimen demonstrated a focal ulcer in the terminal ileum. immunohistochemistry against VZV gpI demonstrated diffuse staining of the muscularis propria and myenteric plexi throughout the length of the specimen. Viral particles consistent with herpesviridae were shown to be present ultrastructurally. We postulate that the viral infection in the neuronal plexi and muscularis propria caused muscle injury leading to pseudo-obstruction.- - - - - - - - - - ranking = 0.016851096893027keywords = rate (Clic here for more details about this article) |
6/24. Controlled transperitoneal percutaneous cecostomy as a therapeutic alternative to the endoscopic decompression for Ogilvie's syndrome.Acute colonic pseudo-obstruction, the so-called Ogilvie's syndrome, results in massive colonic dilation without mechanical obstruction. In most cases, a conservative treatment with or without endoscopic decompression is sufficient. In rare cases of relapses or failures, a cecostomy has to be performed. A surgical cecostomy is associated with high morbidity and mortality. However, a percutaneous cecostomy could be an interesting alternative treatment. We report the case of a 67-yr-old male with colonic pseudoobstruction for which both the conservative and the endoscopic treatments were unsuccessful. A percutaneous cecostomy was performed, and for the first time in this indication, a transperitoneal access was used with the help of nylon T-fasteners.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
7/24. colonic pseudo-obstruction: the dilated colon in the ICU.Acute colonic pseudo-obstruction is a syndrome of massive dilation of the colon without mechanical obstruction that develops in hospitalized patients with serious underlying medical and surgical conditions. Increasing age, cecal diameter, delay in decompression, and status of the bowel significantly influence mortality, which is approximately 40% when ischemia or perforation is present. Evaluation of the markedly distended colon in the intensive care unit setting involves excluding mechanical obstruction and other causes of toxic megacolon such as clostridium difficile infection, and assessing for signs of ischemia and perforation. The risk of colonic perforation in acute colonic pseudo-obstruction increases when cecal diameter exceeds 12 cm and when the distention has been present for greater than 6 days. Appropriate management includes supportive therapy and selective use of neostigmine and colonoscopy for decompression. Early recognition and management are critical in minimizing complications.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
8/24. Percutaneous endoscopic cecostomy: a case series.BACKGROUND: There are few reports of percutaneous endoscopic cecostomy in adult patients. methods: All cases of acute colonic pseudo-obstruction (n = 2) and neurogenic bowel (n = 3) in adults in which percutaneous endoscopic cecostomy was performed were reviewed retrospectively. OBSERVATIONS: Percutaneous endoscopic cecostomy was a definitive treatment. In 1 of the 2 patients with acute colonic pseudo-obstruction, the percutaneous endoscopic cecostomy tube was clamped and subsequently removed 10 weeks after placement; in the other patient with acute colonic pseudo-obstruction, the percutaneous endoscopic cecostomy tube remains in place. In 2 of the 3 patients with neurogenic bowel, the percutaneous endoscopic cecostomy tube continues to function well; the third patient did well for 6 months and then died of underlying comorbid disease. There was no mortality or need for surgical intervention for any patient. Complications occurred in 2 patients; 1 developed transient fever and leukocytosis and 1 had self-limited bleeding during anticoagulation. CONCLUSIONS: Percutaneous endoscopic cecostomy is a safe and effective treatment for both acute colonic pseudo-obstruction and neurogenic bowel when aggressive albeit conservative treatment is unsuccessful.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
9/24. Ogilvie's syndrome.Four cases of Ogilvie's syndrome (acute colonic pseudo-obstruction) are reported. All occurred in the early puerperium following cesarean section and cesarean hysterectomy. In three of the patients, the diameter of the distended cecum was less than 9.0 cm and so management was conservative while in the fourth patient it was more than 9.0 cm, and so surgical intervention was carried out. A cecal diameter of 9.0 cm or above is an indication for surgical intervention to prevent possible colonic perforation. Other indications for surgery include established cecal perforation and failed conservative management. It is important that an early diagnosis is made and management instituted in order to prevent complications and associated high mortality.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
10/24. Acute colonic pseudo-obstruction (Ogilvie's-syndrome) and pneumatosis intestinalis in a kidney recipient patient.Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a clinical entity characterized by massive nontoxic dilatation of the colon in the absence of mechanical obstruction and is associated with increased morbidity and mortality in the immunosuppressed patient. We present a case of a kidney transplant recipient developing a life-threatening condition with acute colonic pseudo-obstruction associated with radiologic findings of a linear pneumatosis intestinalis (PI). Urgent laparotomy and resection of the dilated cecum, colon ascendens and transversum was performed because of bowel necrosis with multiple serosal defects. Stool cultures and special stains for microorganisms were all negative, and there was no evidence for viral or fungal infection. The patient was discharged 31 days after transplantation with normal renal function. In conclusion, this steroid-induced ileus (pseudo-obstruction) is a potentially malignant early form of colonic dysmotility rarely reported in transplant recipients. awareness and early recognition of the condition are critical for a successful outcome. Colonoscopic decompression can achieve reversal of colonic dilatation in most cases, but in some patients prophylactic laparotomy is indicated for prevention of the catastrophic consequences of perforation.- - - - - - - - - - ranking = 1keywords = mortality (Clic here for more details about this article) |
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