Ogilvie syndrome pathophysiology

Ogilvie syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Ogilvie syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ogilvie syndrome pathophysiology On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ogilvie syndrome pathophysiology All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ogilvie syndrome pathophysiology
CDC on Ogilvie syndrome pathophysiology
Ogilvie syndrome pathophysiology in the news
Blogs on Ogilvie syndrome pathophysiology
Directions to Hospitals Treating Ogilvie syndrome
Risk calculators and risk factors for Ogilvie syndrome pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

The colonic pseudo-obstruction pathogenesis is believed to be due to impairment of the autonomic nervous system. The autonomic impairment may involve the parasympathetic fibers of S2-S4 which is responsible for innervation of the distal colon and may lead to atonic colon and proximal obstruction. In few cases, Ogilvie's syndrome (colonic pseudo-obstruction) may show atrophic myopathy with thinned colonic wall and intact myenteric plexus.

Pathophysiology

Pathogenesis

Ogilvie's syndrome

• The association of spinal anaesthesias, drugs and nervous trauma has lead to the understanding that Ogilvie syndrome (colonic dilatation without true obstruction) may be caused by impairment of the autonomic nervous system.
• Damage to the parasympathetic fibers of S2 - S4 causes the distal colon to become atonic and become obstructed proximally.
• However, the exact mechanism is unknown, especially in patients who present with this syndrome without an obvious injury to the parasympathetic nerves.
• Acute colonic pseudo-obstruction occurs when the colon's diameter rises quickly, which increases the tension in the colonic wall, leading to colonic ischemia and possibly, perforation with a diameter exceeding 10 - 12cm.
• A rare case of Ogilvie syndrome showed atrophic myopathy with a thinned out colonic wall, despite a perfectly intact myenteric plexus and unaffected ganglion cells, with no evidence of fibrosis or inflammation.

Paralytic ileus

• The majority of paralytic (adynamic) ileus cases occur after major abdominal surgery, such as hysterectomy.
• Paralytic ileus is thought to occur with manipulation and trauma of the intestinal tract.
• Post operative dysmotility is associated with inflammation, impaired neural reflexes and the release of neural hormone peptides.
  • Inflammation:
    • Intestinal manipulation leads to intestinal ischemia, and shifting of endogenous cellular danger molecules and cytokines away from the site of trauma.
    • Leukocytic infiltration, macrophage and mast cell stimulation commences and causes muscular dysfunction, and therefore inflammation in the manipulated segment.
  • Neural reflexes:
    • Inhibitory sympathetic neural reflexes increase due to noxious spinal afferent signals, therefore, the use of epidural local anesthetics or topical capsaicin is encouraged to prevent paralytic ileus.
  • Neurohormonal peptides:
    • Inhibitory neurotransmitters are released and cause the gut motility to slow down.
    • Inhibitory neurotransmitters include, nitric oxide, vasoactive intestinal polypeptide, and substance P.

Associated conditions

• Ogilvie's syndrome (acute colonic psuedo-obstruction) may be associated with the following conditions:
  • Major surgeries as hip replacement surgery
  • Acute cardiac diseases as myocardial infarction
  • Systemic infections