Akut Kolonik Psödo-Obstruksiyon – Ogilvie Sendromu
Özet
Akut kolonik psödo-obstrüksiyon (ACPO) veya Ogilvie Sendromu, mekanik bir engel olmaksızın kolonun, özellikle çekum ve sağ kolon seviyesinde, masif ve hızlı genişlemesiyle karakterize fonksiyonel bir hastalıktır. Genellikle ciddi cerrahi işlemler, travmalar, metabolik bozukluklar, yanıklar, kardiyak şoklar veya opioid kullanımı gibi ağır komorbiditelerin bir komplikasyonu olarak ortaya çıkar. Erkeklerde ve 60 yaş üzerindeki bireylerde daha sık rastlanır. En belirgin semptomu 24-48 saatte veya kademeli olarak gelişen karın şişliği olup, buna karın ağrısı, bulantı ve kabızlık eşlik edebilir. Standart tanı yöntemi, mekanik tıkanıklığı dışlayan kontrastlı abdomino-pelvik bilgisayarlı tomografidir. Erken tanı konulup tedavi edilmediğinde, çekal çapın 14 cm'yi aşmasıyla birlikte iskemi ve perforasyon riski artar ve ölüm oranı %70'e kadar çıkabilir. Tedavi yaklaşımında ilk adım oral alımın kesilmesi, dekompresyon tüpleri ve IV sıvı desteğini içeren konservatif tedavidir. Bu tedaviye yanıt vermeyen, iskemi belirtisi taşımayan hastalarda parasempatomimetik bir ajan olan neostigmin ile farmakolojik tedavi ilk seçenek olarak uygulanır. İlaç tedavisinin yetersiz kaldığı durumlarda kolonoskopik dekompresyon, dirençli vakalarda veya perforasyon gelişmesi halinde ise cerrahi müdahale zorunludur.
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's Syndrome, is a functional disorder characterized by the acute and rapid dilation of the colon, typically originating in the cecum and right colon, in the absence of any mechanical obstruction. It frequently emerges as a severe complication of underlying comorbidities such as major surgeries, non-surgical trauma, metabolic imbalances, severe burns, cardiogenic shock, or the use of opioid medications. The condition is more prevalent in males and individuals over the age of 60. The hallmark symptom is progressive or rapid abdominal distension developing within 24 to 48 hours, often accompanied by abdominal pain, nausea, and constipation. Contrast-enhanced abdomino-pelvic computed tomography serves as the standard diagnostic tool to confirm proximal dilation and rule out mechanical causes. If left untreated, delayed decompression increases the risk of ischemia and perforation, particularly when the cecal diameter exceeds 14 cm, leading to mortality rates as high as 70%. The primary management strategy relies on conservative treatment, including fasting, proximal gastrointestinal decompression, and intravenous fluid replacement. For patients unresponsive to conservative measures without signs of ischemia, pharmacological therapy with neostigmine is preferred. Refractory cases require colonoscopic decompression, whereas surgical intervention is reserved for perforation or failure of endoscopic approaches.
Referanslar
Ogilvie HJBMJ. Large-intestine colic due to sympathetic deprivation. 1948;2(4579):671.
Dudley HJJCSE. Intestinal pasudo-obstruction. 1958;3:206-17.
John AA, Anand R, Frost J, Griswold JA. Acute Colonic Pseudo-Obstruction: A critical complication in burn patients. Burns Open. 2022;6(1):37-41.
Inagaki Y, Matsuo K, Nakano Y et al. Acute colonic pseudo-obstruction and rapid septic progression after transabdominal preperitoneal hernia repair: a case report. BMC Surgery. 2021;21(1).
Naveed M, Jamil LH, Fujii-Lau L et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointestinal Endoscopy. 2020;91(2):228-35.
Ross SW, Oommen B, Wormer BA et al. Acute colonic pseudo-obstruction: defining the epidemiology, treatment, and adverse outcomes of Ogilvie's syndrome. 2016;82(2):102-11.
Bode WE, Beart Jr RW, Spencer RJ et al. Colonoscopic decompression for acute pseueteobstruction of the colon (Ogilvie's syndrome): Report of 22 cases and review of the literature. 1984;147(2):243-5.
Mahima T, Marcus C, Jeremy G. A case of acute-colonic pseudo-obstruction (Ogilvie Syndrome) post robot-assisted radical prostatectomy. Urology Case Reports. 2022;40(101878-).
Jeremy V, Jason K, Ioannis E. Acute Pancreatitis with Colonic Pseudo-obstruction in a Patient with COVID-19. Case Reports in Gastroenterology. 2022;16(1):97-102.
Christensen K, Ostersen LH, Glavind K et al. Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2020;252:418-23.
Wells CI, O’Grady G, Bissett IPJWjog. Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms. 2017;23(30):5634.
Nanni C, Garbini A, Luchetti P et al. Ogilvie's syndrome (acute colonic pseudo-obstruction). 1982;25(2):157-66.
Schuffler MD, Jonak ZJG. Chronic idiopathic intestinal pseudo-obstruction caused by a degenerative disorder of the myenteric plexus: the use of Smith's method to define the neuropathology. 1982;82(3):476-86.
Harnsberger CR. Acute colonic pseudo-obstruction (Ogilvie's syndrome). Seminars in Colon and Rectal Surgery. 2019;30(3):100690.
Godfrey EM, Addley HC, Shaw ASJCC. The use of computed tomography in the detection and characterisation of large bowel obstruction. 2009.
Pereira P, Djeudji F, Leduc P et al. Ogilvie's syndrome–acute colonic pseudo-obstruction. Journal of Visceral Surgery. 2015;152(2):99-105.
Barth X, Chenet P, Hoen J et al. La colectasie aiguë idiopathique ou syndrome d'ogilvie: à propos de 43 observations. 1991;87(3):230-6.
Vogel JD, Feingold DL, Stewart DB et al. Clinical practice guidelines for colon volvulus and acute colonic pseudo-obstruction. 2016;59(7):589-600.
Vanek VW, Al-Salti MJDotc, rectum. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). 1986;29(3):203-10.
Sloyer AF, Panella VS, Demas BE et al. Ogilvie's syndrome. 1988;33(11):1391-6.
Tobin G, Giglio D, Lundgren OJApP. Muscarinic receptor subtypes in the alimentary tract. 2009;60(1):3.
Kayani B, Spalding DR, Jiao LR et al. Does neostigmine improve time to resolution of symptoms in acute colonic pseudo-obstruction? 2012;10(9):453-7.
Saunders MDJBp, gastroenterology rc. Acute colonic pseudo-obstruction. 2007;21(4):671-87.
Valle RGL, Godoy FLJAom, surgery. Neostigmine for acute colonic pseudo-obstruction: a meta-analysis. 2014;3(3):60-4.
Sgouros SN, Vlachogiannakos J, Vassiliadis K et al. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. 2006;55(5):638-42.
De Giorgio R, Knowles CJJoBS. Acute colonic pseudo-obstruction. 2009;96(3):229-39.
