Algorithm for the Treatment of Acute Colonic Pseudo-Obstruction - Flowchart
Algorithm for the Treatment of Acute Colonic Pseudo-Obstruction - Flowchart Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome)
«Flowchart»

Cecal diameter >9 cm
Mechanical obstruction ruled out

Cecal diameter >9 cm
Mechanical obstruction ruled out

Cecal diameter >9 cm
Mechanical obstruction ruled out


Resume standard care

Resume standard care

Resume standard care

End

End

End

Consider gentle water-soluble enema

Consider gentle water-soluble enema

Consider gentle water-soluble enema

Infuse neostigmine 1-2 mg over 3-5 min
Monitor cardiac rhythm and vital signs
Repeat neostigmine in 4 hr if no response or dilatation recurs
Give atropine 0.5-1 mg for bradycardia

Infuse neostigmine 1-2 mg over 3-5 min
Monitor cardiac rhythm and vital signs
Repeat neostigmine in 4 hr if no response or dilatation recurs
Give atropine 0.5-1 mg for bradycardia

Infuse neostigmine 1-2 mg over 3-5 min
Monitor cardiac rhythm and vital signs
Repeat neostigmine in 4 hr if no response or dilatation recurs
Give atropine 0.5-1 mg for bradycardia




No response

No response

No response

Repeat colonic decompression
Use decompression tube if not used initially

Repeat colonic decompression
Use decompression tube if not used initially

Repeat colonic decompression
Use decompression tube if not used initially


Resume standard care

Resume standard care

Resume standard care

Endoscopic decompression
Gentle saline enema preparation or no preparation
Do not overinflate the colon
If a decompression tube is placed, advance it at least to transverse colon

Endoscopic decompression
Gentle saline enema preparation or no preparation
Do not overinflate the colon
If a decompression tube is placed, advance it at least to transverse colon

Endoscopic decompression
Gentle saline enema preparation or no preparation
Do not overinflate the colon
If a decompression tube is placed, advance it at least to transverse colon




Response

Response

Response

No response

No response

No response

Brief response

Brief response

Brief response

Surgery

Surgery

Surgery

Cecostomy
Endoscopic
Radiologic
Surgical

Cecostomy
Endoscopic
Radiologic
Surgical

Cecostomy
Endoscopic
Radiologic
Surgical




Fever, abdominal pain, signs of peritonitis or free air, ↑ WBC

Fever, abdominal pain, signs of peritonitis or free air, ↑ WBC

Fever, abdominal pain, signs of peritonitis or free air, ↑ WBC

↑

Present

Present

Present

Not present

Not present

Not present

No or brief response

No or brief response

No or brief response

* Contraindications to neostigmine:


Systolic BP <90 mm Hg
Bradycardia
Bronchospasm
Serum creatinine >3 mg/dl
Perforated bowel
History of intolerance to neostigmine

* Contraindications to neostigmine:


Systolic BP <90 mm Hg
Bradycardia
Bronchospasm
Serum creatinine >3 mg/dl
Perforated bowel
History of intolerance to neostigmine

* Contraindications to neostigmine:

*


Systolic BP <90 mm Hg
Bradycardia
Bronchospasm
Serum creatinine >3 mg/dl
Perforated bowel
History of intolerance to neostigmine


Systolic BP <90 mm Hg
Bradycardia
Bronchospasm
Serum creatinine >3 mg/dl
Perforated bowel
History of intolerance to neostigmine

Neostigmine contraindicated*

Neostigmine contraindicated*

* * Neostigmine contraindicated

Neostigmine not contraindicated

Neostigmine not contraindicated

Neostigmine not contraindicated

Treat reversible causes (infection, electrolyte disturbances, medications, volume depletion) Keep patient NPO

Treat reversible causes (infection, electrolyte disturbances, medications, volume depletion) Keep patient NPO

Treat reversible causes (infection, electrolyte disturbances, medications, volume depletion) Keep patient NPO

Response

Response

Response

No response after 72 hr

No response after 72 hr

No response after 72 hr