This protocol addresses patients with acute colonic pseudo-obstruction (Ogilvie's syndrome) — massive dilation of the large intestine without a mechanical cause — who have no ischemia, no perforation, and no signs of peritonitis, but in whom endoscopic decompression has not achieved resolution of colonic distention.
Acute colonic pseudo-obstruction without ischemia, without perforation, and without signs of peritonitis. Conservative and pharmacologic approaches, as well as endoscopic management, have already been attempted and have not produced the required clinical result.
The preceding intervention was colonic decompression with decompression tube placement, performed by an experienced endoscopist using water infusion and minimal insufflation, with appropriate sedation. The required goal — resolution of colonic distention — was not achieved. This protocol describes the next appropriate step after that failure.
When conservative, pharmacologic, and endoscopic options have all failed, surgical intervention is the appropriate next step in management. The full protocol specifies which surgical approach applies to this clinical situation.