SAEM Clinical Image Series: Distended Bowels

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Chief Complaint: Abdominal distention

History of Present Illness: A 36-year-old male with a history of cerebral palsy, gastrointestinal dysmotility, epilepsy, hypertension, gastroesophageal reflux disease, and insomnia presents to the ED after referral by his family physician for a 3-day history of abdominal distention. Due to the patient’s neurological disorder, he is unable to communicate but is accompanied by his mother who provides his medical history. The patient’s mother states that he had a loose bowel movement this morning, which is normal for him. He has had a history of bowel problems since the age of 14. Two months previously the patient was admitted for abdominal distention and had a rectal tube placed which relieved his symptoms. The patient has not experienced nausea, vomiting, or changes in bowel movements.

Physical Exam

Vitals:

BP 145/104
Pulse 82
Respiration Rate 18
Temp 97.7C

General: Patient is lying in bed in no acute distress

Abdominal: Abdomen is grossly distended, tympanic to percussion, and bowel sounds are present in all 4 quadrants and not high-pitched

Neurologic: Patient is nonverbal but able to follow mother’s commands; unable to assess cranial nerves

Rectal: Tense rectal tone

Laboratory Data

A BMP and CBC were both within normal limits.

Case Question: What is the diagnosis? What IV drug can be used for rapid colonic decompression in this condition?

Ogilvie Syndrome

Neostigmine can be given IV to cause rapid colonic decompression.

Case Answer/Discussion

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.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.

Author information

Benjamin Gibson

Medical Student
University of South Alabama College of Medicine

The post SAEM Clinical Image Series: Distended Bowels appeared first on ALiEM.

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