Presenter Status
Fellow
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Dr. Aileen Har
Presentation Type
Poster
Start Date
19-5-2026 11:00 AM
End Date
19-5-2026 12:00 PM
Abstract Text
Background: Acute colonic pseudo-obstruction (ACPO) or Ogilvie’s syndrome is a disorder that most commonly occurs in the cecum and right colon but can extend to the rectum and is noted as an acute dilatation without presence of an obstructive lesion (1). Those patients who are usually diagnosed with this disorder are above the age of 60 and have a predisposing risk factor such as hospitalization, long-term care facilities, severe illness, post-surgery, or metabolic/medication causes like antipsychotics and chemotherapy medications (2). There is an association with hypothyroidism but otherwise there are no pathognomonic laboratory findings in these patients (3). Abdominal CT will show proximal colonic dilatation which can extend to the rectum with an intermediate transitional zone. Initial treatment of choice is supportive care, but if there are severe symptoms or cecal diameter is >12cm, Neostigmine can be used. If Neostigmine fails, then the patient will either have to undergo colonoscopic decompression or surgical intervention (4). There is limited data describing Ogilvie’s syndrome in children, but one article does describe the use of Neostigmine for treatment of Ogilvie’s syndrome in pediatric hematologic malignancies (5). The case described below is that of a medically complex teenager admitted for septic shock and acute respiratory failure, whose course was complicated by diagnosis of Ogilvie’s syndrome.
Conclusions: Acute Colonic pseudo-obstruction is a rare cause of abdominal distension in the pediatric population but should not be entirely forgotten about in complex hospitalized patients. Most common risk factors in adults include non-operative trauma, infection, malignancy and cardiac disease. It has been shown in those patients who are not treated, 3-15% of cases may lead to intestinal perforation and increased mortality rate up to 50% (5). Diagnosis takes clinical suspicion as it is uncommon in the pediatric population. In our case, the patient above did present with significant distension and significant CT findings concerning for ACPO. He was then treated using adult recommendations including Erythromycin, Neostigmine, and ultimately colonic decompression. In one study published by Lee et al, ten pediatric patients with malignancy were diagnosed with ACPO. In this study, all ten of the patients were treated with Neostigmine after supportive care was ineffective. Half of the patients showed improvement after two doses and there was an overall positive response to Neostigmine 80% of the time. The rest of the patients then had to progress to more invasive management.
Taking into consideration this case in addition to other reports such as above in Lee et al., it is important for gastroenterologists to recognize signs and symptoms that are suggestive of ACPO and intervene quickly due to increased risk of mortality. Often in collaboration with primary teams, patients such as in this case, we can initiate medical treatment that may lead to resolution of symptoms early and prevent need for additional invasive procedures.
A Rare Instance of Ogilvie Syndrome in a Pediatric Patient with a Complex Medical History; A Case Report.
Background: Acute colonic pseudo-obstruction (ACPO) or Ogilvie’s syndrome is a disorder that most commonly occurs in the cecum and right colon but can extend to the rectum and is noted as an acute dilatation without presence of an obstructive lesion (1). Those patients who are usually diagnosed with this disorder are above the age of 60 and have a predisposing risk factor such as hospitalization, long-term care facilities, severe illness, post-surgery, or metabolic/medication causes like antipsychotics and chemotherapy medications (2). There is an association with hypothyroidism but otherwise there are no pathognomonic laboratory findings in these patients (3). Abdominal CT will show proximal colonic dilatation which can extend to the rectum with an intermediate transitional zone. Initial treatment of choice is supportive care, but if there are severe symptoms or cecal diameter is >12cm, Neostigmine can be used. If Neostigmine fails, then the patient will either have to undergo colonoscopic decompression or surgical intervention (4). There is limited data describing Ogilvie’s syndrome in children, but one article does describe the use of Neostigmine for treatment of Ogilvie’s syndrome in pediatric hematologic malignancies (5). The case described below is that of a medically complex teenager admitted for septic shock and acute respiratory failure, whose course was complicated by diagnosis of Ogilvie’s syndrome.
Conclusions: Acute Colonic pseudo-obstruction is a rare cause of abdominal distension in the pediatric population but should not be entirely forgotten about in complex hospitalized patients. Most common risk factors in adults include non-operative trauma, infection, malignancy and cardiac disease. It has been shown in those patients who are not treated, 3-15% of cases may lead to intestinal perforation and increased mortality rate up to 50% (5). Diagnosis takes clinical suspicion as it is uncommon in the pediatric population. In our case, the patient above did present with significant distension and significant CT findings concerning for ACPO. He was then treated using adult recommendations including Erythromycin, Neostigmine, and ultimately colonic decompression. In one study published by Lee et al, ten pediatric patients with malignancy were diagnosed with ACPO. In this study, all ten of the patients were treated with Neostigmine after supportive care was ineffective. Half of the patients showed improvement after two doses and there was an overall positive response to Neostigmine 80% of the time. The rest of the patients then had to progress to more invasive management.
Taking into consideration this case in addition to other reports such as above in Lee et al., it is important for gastroenterologists to recognize signs and symptoms that are suggestive of ACPO and intervene quickly due to increased risk of mortality. Often in collaboration with primary teams, patients such as in this case, we can initiate medical treatment that may lead to resolution of symptoms early and prevent need for additional invasive procedures.
Comments
Poster board Number: 6