Characterized by acute massive colon dilatation involving primarily the right side of the colon and without a mechanical cause
Aetiology
Most common in frail/elderly patients
Conditions commonly associated with Olgilvie's syndrome include:
Recent surgery e.g. hip replacement surgery, CABG
Recent trauma e.g. spinal fracture
Recent severe illness e.g. pneumonia
Electrolyte imbalance or endocrine disorders e.g. hypercalcaemia
Medication e.g. opioids
Neurological disease e.g. Parkinson’s disease
Pathophysiology
Most commonly affects the caecum and ascending colon, however can affect the whole bowel
Exact mechanism is unknown; it is thought to be due to an interruption of the autonomic nervous supply to the colon resulting in the absence of smooth muscle action in the bowel wall
Clinical presentation
Symptoms
Most patients will present with the clinical features of mechanical bowel obstruction - abdominal pain, abdominal distension, constipation, vomiting
Signs
On examination the abdomen will be distended and tympanic
Investigations
AXR will show bowel distension
Abdominal-pelvis CT scan with IV contrast - will show dilatation of the colon, as well as definitively excluding a mechanical obstruction and assessing for any complications
Management
Most cases can be managed conservatively (nil-by-mouth, IV fluids) - with aggressive management the massive colon dilatation can resolve and normal function can return
Colonic decompression may be required if distension is causing pain or respiratory compromise
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