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1/96. 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. ( info)

2/96. 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. ( info)

3/96. 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. ( info)

4/96. Conservative management of acute pseudo-obstruction in a major burn.

    We present a case of recurrent acute colonic pseudo-obstruction (ACPO) in a burn patient that responded to a postural change which has not been previously reported. ( info)

5/96. Colonic spasm and pseudo-obstruction in an elongated colon secondary to physical exertion: diagnosis by stress barium enema.

    Anatomic and functional abnormalities of the colon are known to cause a variety of abdominal complaints, including constipation, diarrhea, and pain. We describe a patient with dolichocolon (elongated colon) with transient spasm (pseudo-obstruction) associated with exertion. The diagnosis in this case rested with a novel approach and less invasive evaluation of the colon. ( info)

6/96. Ogilvie's syndrome as a rare complication of lumbar disc surgery.

    BACKGROUND: In this study we report a rare complication after lumbar surgery, Ogilvie's syndrome, that presents as acute colonic dilatation in the absence of mechanical obstruction. CASE: A 43-year-old obese woman underwent lumbar surgery for L4-L5 lumbar disc herniation. The patient complained of persistent abdominal distention and lack of bowel sounds. Plain radiography and ultrasonography revealed massive dilatation of the colon. Nasogastric aspiration was initiated and all analgesic drugs were withdrawn. Abdominal distention gradually disappeared within three days. CONCLUSIONS: Only three cases of Ogilvie's syndrome following lumbar spinal surgery have been reported in the literature. In our case obesity, chronic constipation, and narcotic drugs were the most likely precipitating causes. Ogilvie's syndrome may resolve with conservative treatment, but if the cecal diameter continues to increase, colonoscopy or laparotomy may be needed to prevent perforation of colon. ( info)

7/96. Ogilvie's syndrome associated with acute cytomegaloviral infection after liver transplantation.

    Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a rare complication following liver transplantation. We describe two cases in which the onset of Ogilvie's syndrome is strongly temporally associated with acute cytomegaloviral (CMV) infection in immunosuppressed liver transplant recipients. The pseudo-obstruction resolved rapidly in both cases following treatment with intravenous ganciclovir. Acute CMV infection therefore appeared to be causally linked to pathogenesis of Ogilvie's syndrome in these two cases. This association has not been described previously to our knowledge, and should be considered in any transplant patient presenting with Ogilvie's syndrome. ( info)

8/96. 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. ( info)

9/96. 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. ( info)

10/96. Ogilvie's syndrome (colonic pseudo-obstruction) occurring in an 18-year-old Nigerian female.

    Ogilvie's syndrome which is colonic obstruction without an identifiable distal mechanical cause is reported in an 18 year old female Nigerian. A high index of awareness is required to diagnose this condition. ( info)
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