This protocol covers acute colonic pseudo-obstruction (Ogilvie's syndrome) presenting as uncomplicated: no ischemia, no perforation, and no signs of peritonitis. The condition is characterised by acute massive dilation of the large intestine in the absence of a mechanical obstruction.
The absence of ischemia, perforation, and peritoneal signs identifies this as an uncomplicated presentation. Conservative management is the established first-line approach; pharmacological intervention follows a structured evidence-based pathway when clinically warranted.
When pharmacological intervention is indicated, this protocol involves neostigmine administered via a specific route of delivery — the complete selection criteria, administration strategy, monitoring requirements, and sequencing are detailed in the full regimen.
The primary clinical endpoint is passage of stool and flatus, confirming resolution of the functional colonic obstruction.
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.
In a recent, multicenter, retrospective, observational study of 182 patients with ileus, ACPO, or refractory constipation, subcutaneous neostigmine resulted in passage of stool within a median time of 29 hours.
A continuous neostigmine infusion of .4 to .8 mg/h over 24 hours resulted in passage of stool and flatus in 19 of 24 patients in comparison with 0 patients in the placebo arm.
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