Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is characterised by an acute, massive dilation of the large intestine in the absence of a mechanical cause. When there is no ischemia, no perforation, and no signs of peritonitis, the presentation is considered uncomplicated — a distinction that directly shapes the clinical approach.
This protocol applies to patients presenting with ACPO who have no evidence of ischemia, no perforation, and no clinical signs of peritonitis. In this uncomplicated setting, a conservative first-line strategy is the established standard.
Management is conservative in nature, focusing on gut rest, correction of underlying contributing factors, and supportive care — the complete structured protocol defines the specific components and the monitoring window required before escalation is considered.
The primary targets are resolution of colonic distention within 48–72 hours and a cecal diameter below 12 cm. Serial monitoring of cecal diameter is important, as progressive dilation increases the risk of perforation.
ACPO, synonymous with Ogilvie's syndrome, is characterized by an acute presentation of massive dilation of the large intestine in the absence of a mechanical etiology.
In patients with uncomplicated ACPO (absence of ischemia, peritonitis, cecal diameter >12 cm, and/or significant abdominal pain), conservative management remains first-line therapy.
For patients with uncomplicated ACPO (absence of ischemia, peritonitis, cecal diameter <12 cm, and/or significant abdominal pain), we recommend conservative therapy as the preferred initial management including identifying and correcting potentially contributing metabolic, infectious, and pharmacologic factors.
Serial assessment of the cecal diameter is prudent given the risk of perforation with cecal diameters greater than 12 cm.
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