Treatment of Acute Colonic Pseudo-obstruction Without Ischemia, Perforation, or Peritonitis
Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is characterised by massive dilation of the large intestine in the absence of a mechanical cause. When the presentation is uncomplicated — without ischemia, without perforation, and without peritonitis — a specific evidence-based treatment pathway applies.
Clinical Scenario
This protocol addresses patients presenting with acute colonic pseudo-obstruction without ischemia, without perforation, and without signs of peritonitis. In this uncomplicated setting, conservative management is the established first-line approach, and pharmacological intervention with neostigmine is central to the escalation strategy.
Treatment Direction
For patients with uncomplicated ACPO who have not achieved adequate colonic decompression with initial pharmacological therapy, the evidence-based protocol specifies an additional neostigmine-based step. The full sequencing, patient selection criteria, and monitoring requirements are detailed in the complete protocol.
References
DOI: 10.1016/j.gie.2019.09.007
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 ACPO who do not respond to a first dose of neostigmine, we suggest the administration of a second dose of neostigmine.
In patients who fail an initial dose of neostigmine, are partial responders, or have recurrence, a second dose has been associated with clinical response in 40% to 100%.
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