[Diagnostic problems, pathogenetic hypothesis and therapeutic proposals in Ogilvie's syndrome. Review of 470 observations from the literature and presentation of 5 new cases].
The authors describe five cases of acute pseudo-obstruction of the colon: the first, alcoholic, treated with antidepressant drugs, with a long history of intestinal occlusions and explorative laparotomies, treated successfully by conservative therapy; the second, with meningitis, in which right colectomy for the presence of multiple perforations of the cecum was performed; the third with acute neurological problems of ischemic nature, died before any treatment was given; the fourth, with left hemicolectomy performed for cancer, in which transversostomy was performed after colonoscopy and medical treatment with prokynetic drugs had failed; the last one, in a young woman treated with anti-depressant and antipsychotic drugs, treated by conservative therapy. In reviewing 470 cases from the literature the most commonly associated disorders are found; 33 patients (7%) were diagnosed as idiopathic. Only 273 cases were available for detailed analysis of age, sex, mode of treatment, presence of perforation, mortality rate. The mortality rate was 17.6%. When comparing the different treatment procedures, surgery has a higher mortality rate (23.5%) than medical treatment or colonoscopy (12.1%) (p < 0.02). In this study the presence of perforation increased mortality from 15.1% to 29.9% (p < 0.03). The mortality rate for cecostomy is 15.3% vs 30.1% for other surgical procedures. Recently the syndrome pathogenesis is attributed to an autonomic imbalance, between the sympathetic and parasympathetic innervation of the colon: sympathetic prevalence due to sacral parasympathetic derangement, lead to inhibition of colonic peristalsis. The attention must be focused on early diagnosis and prompt treatment; for this purpose colonoscopy seams to be a safe method of establishing the diagnosis and carrying out treatment.