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 features

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