The plain film demonstrates massive dilatation of the sigmoid colon. The CT demonstrates massive dilatation of the descending and particularly the sigmoid with a transition in the distal sigmoid. No focal lesion or obstructing process identified.
These findings are consistent with Ogilvie's syndrome or Pseudoobstruction of the colon.
- Can be acute or chronic
- Acute needs rapid decompression especially when there is dilatation of the cecum (to prevent rupture).
- Not paralytic ileus as it has a transition but not obstructive as no stricture will be found and the air should change with position.
- Treatment - can be conservative - NG, enemas, neostigmine - or aggressive with colonoscopic decompression or even percutaneous cecostomy.
- Loss of parasympathetic ganglions may be a factor
- Transition is often seen at splenic flexure (not our case) which may be related to change in parasympathetic control from vagus to sacral nerves at this level.
- Acute - often related to recent surgery (of any sort) or major illness.
- Chronic - recurrent and rarely perforates.
References: http://www.ajronline.org/cgi/content/full/190/6/1521 ; http://radiographics.rsnajnls.org/cgi/reprint/6/6/995.pdf
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