DIAGNOSTIC DIFFICULTIES OF COLONIC PSEUDO-OBSTRUCTION IN ADULT PATIENTS

Octavian Andronic; Dan Nicolae Păduraru; Alexandra Bolocan; Cristina Veronica Andreescu; Daniel Ion; Alexandru Constantinescu; Florentina Mușat

Octavian Andronic Department of General and Emergency Surgery, University Emergency Hospital of Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Dan Nicolae Păduraru Department of General and Emergency Surgery, University Emergency Hospital of Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Alexandra Bolocan Department of General and Emergency Surgery, University Emergency Hospital of Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Cristina Veronica Andreescu Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Daniel Ion Department of General and Emergency Surgery, University Emergency Hospital of Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Alexandru Constantinescu Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Department of Gastroenterology, University Emergency Hospital of Bucharest, Romania
Florentina Mușat Department of General and Emergency Surgery, University Emergency Hospital of Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Keywords: Acute colonic pseudo-obstruction, ACPO, Ogilvie syndrome, diagnosis

Abstract

Acute colonic pseudo-obstruction (ACPO), known as Ogilvie syndrome is defined by the dilation of the colon and rectum in the absence of a mechanical obstruction and was first described by Heneage Ogilvie in 1948. After analyzing the current literature, we highlighted the lack of a defined diagnostic algorithm for ACPO. The present study aims to identify the diagnostic criteria necessary to guide the clinician in choosing the right therapeutic management and avoiding unnecessary laparotomies. The lack of high-quality studies makes it impossible to perform systematic meta-analyzes or reviews to address the problem of Ogilvie syndrome diagnosis. Various attempts to standardize the therapeutic protocol in the case of these patients can be identified in the literature, however no consensus has been reached regarding a diagnostic algorithm. After analyzing the literature, we identified and grouped criteria of ACPO that can be used in the rapid assessment of patients with suspected Ogilvie syndrome. We organized those features in 5 categories: the patient background, the symptoms, clinical exam, laboratory tests and imaging studies. We consider that the diagnosis of ACPO can be made in a patient who has at least one criterion from each of the 5 categories. Oglivie syndrome / ACPO is an underdiagnosed entity whose management often includes an unnecessary laparotomy that can have negative repercussions on the patient's life. On the other hand, the delay of the surgical management in case of complications is associated with an increased mortality.

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