Ogilvie's syndrome, also known as acute
colonic pseudo-obstruction, refers to pathologic dilation of the colon without underlying mechanical obstruction, occurring primarily in patients with serious comorbidities. Diagnosis of
Ogilvie's syndrome is based on clinical and radiologic grounds, and can be treated conservatively or with interventions such as
acetylcholinesterase inhibitors (such as
neostigmine), decompressive procedures including colonoscopy, and even surgery. Based on our clinical experience we hypothesized that
conservative management yields similar, if not superior, results to interventional management. Therefore, we retrospectively examined all patients over the age of 18 with
Ogilvie's syndrome who presented to the Medical University of South Carolina (MUSC). The diagnosis of
Ogilvie's syndrome was confirmed by clinical criteria, including imaging evidence of colonic dilation ≥9 cm. Patients were divided and analyzed in 2 groups based on
management: conservative (observation, rectal tube, nasogastric tube, fluid
resuscitation, and correction of
electrolytes) and interventional (
neostigmine, colonoscopy, and surgery). Use of
narcotics in relation to maximal bowel size was also analyzed. Over the 11-year study period (2005-2015), 37 patients with
Ogilvie's syndrome were identified. The average age was 67 years and the average maximal bowel diameter was 12.5 cm. Overall, 19 patients (51%) were managed conservatively and 18 (49%) underwent interventional management. There was no significant difference in bowel dilation (12.0 cm vs 13.0 cm; P = .21), comorbidities (based on the Charlson Comorbidity Index (CCI), 3.2 vs 3.4; P = .74), or
narcotic use (P = .79) between the conservative and interventional management groups, respectively. Of the 18 patients undergoing interventional management, 11 (61%) had
Ogilvie's-syndrome-related complications compared to 4 (21%) of the 19 patients in the
conservative management group (P < .01). There was no difference in overall
length of stay in the 2 groups. Two patients, one in each group, died from complications unrelated to their
Ogilvie's syndrome. We conclude that
Ogilvie's syndrome, although uncommon, and typically associated with severe underlying disease, is currently associated with a low inpatient mortality. While interventional management is often alluded to in the literature, we found no evidence that aggressive measures lead to improved outcomes.