*95-year-old female present with constipation, vomiting and abdominal distension.
What is the most likely diagnosis?
Answer
Answer:
Colonic pseudo-obstruction (Ogilvie syndrome)
Case Discussion:
CT ve VRT images revealed gross colonic dilatation from cecum to anus without obstructing lesion.
Colonic pseudo-obstruction (also known as Ogilvie syndrome) is a potentially fatal condition leading to an acute colonic distention without obstructing lesion.
Patients usually present with constipation, nausea, vomiting and abdominal distension. Ogilvie syndrome can present with a sudden painless enlargement of the proximal colon accompanied by distension.
Risk factors include:
trauma
burns
recent surgery
medications
opioids
phenothiazines
clozapine
respiratory failure
electrolyte disturbances
diabetes mellitus
uraemia
On CT, the hallmark of colonic pseudo-obstruction is the presence of dilatation of the large bowel without evidence of an abrupt transition point or mechanically obstructing lesion.
Complication: Caecal perforation
Differential diagnosis:
adynamic ileus
mechanical large bowel obstruction
toxic megacolon secondary to Clostridium difficile colitis
ischemic colitis
sigmoid volvulus and caecal volvulus
References:
1. Lang EV, Carson L, Gossler A. Gas lock obstruction of the colon: Ogilvie’s syndrome revisited. AJR Am J Roentgenol. 1998;171 (4): 1014-6.
2. Choi JS, Lim JS, Kim H et-al. Colonic pseudoobstruction: CT findings. AJR Am J Roentgenol. 2008;190 (6): 1521-6.
3. Maloney N, Vargas HD. Acute intestinal pseudo-obstruction (Ogilvie’s syndrome). Clin Colon Rectal Surg. 2005;18 (02): 96-101.