P1984 - Ogilvie’s Syndrome: Is Colonic Resection a Good Option for Patients With Multiple Admissions

Fahad K. Durrani, MD¹, Arlen O.. Ventura C., MD², Juan Cosico, MD^1
1NYC Health + Hospitals/Metropolitan, New York, NY; ²NYC Health + Hospitals/Metropolitan, Bronx, NY

Introduction: Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare disease characterized by dilation of the colon in the absence of an identifiable mechanical obstruction. The diagnosis is often overlooked due to variable presentation in older adults. Early recognition and appropriate management can prevent fatal complications including bowel ischemia, perforation and peritonitis.

Case Description/Methods: We present a case of a 71 year old female with a past medical history of diabetes mellitus and hypertension presented with constipation and abdominal distention for one week. The abdominal distension got worse in the last 2 days. She has had a history of multiple admissions with similar presentation recently. Physical examination showed a tense abdomen with tenderness. Careful review of the medications was negative for offending medications. Laboratory data revealed a potassium of 2.1 mEq/L. Xray abdomen revealed massively dilated air-filled loop of sigmoid colon consistent with obstruction or severe ileus. CT abdomen confirmed presence of severely dilated small and large intestine. Further investigations were done for other diseases associated with abdominal distension including hypothyroidism, hyperaldosteronism, cushing’s disease and clostridium difficle, all of which were negative.

Potassium was replaced aggressively with normalization of its level. General Surgery was consulted, and they decided to insert nasogastric and rectal tube that resulted in progressive relief of abdominal distention. Colonoscopy was done that showed presence of dilated colon with extensive amounts of liquid stool without any obvious obstructive mass, it was followed by colonoscopic decompression.

Considering repeated admissions with similar presentations, the general surgery team recommended total colectomy with end ileostomy. Patient agreed and underwent the surgical procedure with no immediate post operative complications.

Discussion: Our patient presented with classical symptoms of ACPO including abdominal distention, constipation and abdominal tenderness. An initial attempt was made to manage it with potassium replacement, Nasogastric and Rectal tube placement, endoscopic decompression followed by surgical resection. Although priority should always be to manage it with conservatively, for patients who have multiple admissions with similar presentation may be offered colonic resection hoping to find a permanent solution to the problem


Disclosures:


Fahad K. Durrani, MD¹, Arlen O.. Ventura C., MD², Juan Cosico, MD¹. P1984 - Ogilvie’s Syndrome: Is Colonic Resection a Good Option for Patients With Multiple Admissions, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.