Gastroenterology MCQ Answer 22

Answer: d



Acute pseudo-obstruction of the colon, known as Ogilvie’s syndrome, is a paralytic ileus of the large bowel characterized by rapidly progressive abdominal distension often without associated pain. Plane radiographs of the abdomen may reveal air in the small bowel and distension of discrete segments of the colon (cecum or transverse colon) or the entire abdominal colon. Distension can become impressive, oftentimes in chronic cases distension in excess of 15 cm can be observed without evidence of colon perforation or wall ischemia. Major risk factors for the development of Ogilvie’s syndrome include severe blunt trauma, orthopedic trauma or procedures, acute cardiac events or coronary bypass surgery, acute neurologic events or neurosurgical procedures, and acute metabolic derangements. Initial management includes resuscitation and correction of the underlying metabolic and electrolyte abnormalities. A nasogastric tube is indicated if the patient is vomiting and will prevent swallowed air from passing distally. If distension is painless and the patient shows no signs of toxicity or bowel ischemia, expectant management can be successful in about 50% of cases. If distension worsens so that the cecal diameter increases beyond 10–12 cm or if it persists for more than 48 hours, colonoscopy is recommended. Endoscopic decompression is successful in 60–90% of cases, but colonic distension may recur in up to 40% of cases. Rectal tubes are ineffective in managing distension of the proximal colon, however, such tubes may be useful after colonoscopy.

Category: Gastroenterology MCQs