IS Case 400: Acute colonic pseudo-obstruction (Ogilvie's syndrome)

Gurpreet Dhillon, MD

2009 URMC Imaging Sciences
Publication Date: 2010-03-09


Patient is a 60-year-old male with history of multiple sclerosis with increased abdominal distention and difficulty urinating.


Dilated, stool-filled colon from the cecum to the sigmoid with a collapsed rectum.


Acute colonic pseudo-obstruction (Ogilvie's syndrome)


Acute colonic pseudo-obstruction is a clinical disorder with the signs, symptoms, and radiographic appearance of an acute large bowel obstruction with no evidence of distal colonic obstruction. Massive dilatation of the colon is seen with risk of perforation, peritonitis, and death if not decompressed. Though the pathophysiology is not clearly understood, it is believed that an imbalance in the autonomic innervation appears to lead to a functional (not mechanical) obstruction.

Conventional radiographs and CT show dilated loops of large bowel mimicking distal colonic obstruction. Serial films can be used to follow the clinical course and response to therapy. CT can be used to exclude the presence of frank perforation, obstruction, and toxic megacolon.

Treatment with a parasympathomimetic drug (such as neostigmine) or with colonoscopic decompression is often successful. Decompression must be considered and expedited if the colon diameter exceeds 10 cm.


  1. Skucas J. Advanced Imaging of the Abdomen. Springer, 2006.
  2. De Giorgio R, Knowles CH. Acute colonic pseudo-obstruction. Br J Surg. 2009 Mar;96(3):229-39. PMID: 19224517

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