SAEM Clinical Image Series: Distended Bowels

Ogilvie syndrome is a rare condition characterized by non-obstructive colonic distension due to loss of proper peristalsis. The condition is most common in patients with underlying medical conditions and those that are hospitalized, institutionalized, or have recently undergone surgery.

Patients typically present with abdominal distension and pain, nausea, and vomiting. Complications include ischemic bowel and perforation, and therefore rapid treatment is imperative. Diagnosis is based upon the patient’s history, presentation, plain abdominal films, and computed tomography. Acquiring a clear history, physical examination, and imaging is necessary to rule out other forms of colonic distension.

Treatment depends on the severity of the patient’s presentation but includes observational, medical, and surgical options. Medical therapy includes treatment of underlying conditions that may have precipitated colonic dysmotility, discontinuation of any anticholinergic and opioid medications, and the use of neostigmine for rapid decompression. Decompression can also be achieved through placement of a rectal tube. Patients may additionally benefit from a nasogastric tube to reduce the amount of air entering the bowels. Surgical intervention is reserved for those that fail conservative management and includes cecostomy and colectomy depending on the severity of the condition and presence of complications such as bowel ischemia and perforation.