Acute
colonic pseudo-obstruction,
Ogilvie's syndrome, most often appears as a complication of other clinical conditions. It is characterized by massive colonic dilation in the absence of a mechanical cause.
Therapy for this condition has traditionally been colonoscopic
decompression via a flexible
colonoscope. We performed a retrospective study to assess the efficacy of Cystografin
enema for colonic
decompression in
Ogilvie's syndrome. We present a series of 18 patients who developed
Ogilvie's syndrome while hospitalized for
trauma (n = 10),
burn (n = 1), gastrointestinal surgery (n = 4), and hip replacement (n = 3). The mean pre-
enema cecal size was 13 cm (range 10 to 15 cm). The mean postenema cecal size was 8.5 cm (range 6 to 15 cm). Fifteen of the 18 patients underwent Cystografin
enema as the primary mode of
decompression. Three had undergone prior colonoscopy, which had failed. One of the 18 patients required repeat
enema for inadequate
decompression after the first
enema and one underwent colonoscopy for recurrence. Two patients underwent operative intervention after the
enema. There were no complications related to the
enema. In all patients we were able to rule out a mechanical cause of large bowel obstruction. We believe the safety, efficacy, and ease of this procedure make Cystografin
enema optimal first-line treatment for acute
colonic pseudo-obstruction.