Bülent KAYA, Nuriye Esen BULUT, Orhan BAT, Mehmet OKUDUCU, Hasan ALTUN, Kemal MEMİŞOĞLU

Ogilvie sendromu yaşlı hastalarda ciddi morbidite ve mortaliteye sebep olmakta mıdır?

Amaç: Ogilvie sendromu, kolonun akut, masif dilatasyonu ile karakterize bir hastalıktır. Bu hastalığa bağlı morbidite ve mortalite hala önemini korumaktadır. Klinik çalışmamızda Ogilvie sendromu nedeni ile takip ve tedavi ettiğimiz hastaları retrospektif olarak incelemeyi amaçladık. Materyal ve Metot: Nisan 2010 ile Temmuz 2011 tarihleri arasında Ogilvie sendromu tanısı ile takip ve tedavi edilen hastalar retrospektif olarak incelendi. Hastaların yaş, cinsiyet, preoperatif semptom ve fizik muayene bulguları, yandaş hastalıklar, laboratuar sonuçları ve radyolojik bulgular, tedavi ve takip bilgileri kayıt edildi. Sonuçlar Ortalama±standart sapma şeklinde ifade edildi. İstatistiksel analizde SPSS 17 istatistik programı kullanıldı. Bulgular: Çalışma süresinde beş (5) hasta Ogilvie sendromu tanısı ile takip ve tedavi edildi. Hastaların 3’ü erkek 2’si kadındı. Yaş ortalaması 71.4±2 (50-79 arası) olarak tespit edildi. Hastaların şikayetleri 1-5 gün arasında değişmekteydi. Hastalarda görülen en sık şikayet karın ağrısı (4 hasta) idi. Toplam 5 hastaya medikal tedavi başlandı. Üç hastada neostigmin kullanıldı. Bu hastalardan ikisine laparatomi yapıldı. Cerrahi tedavi ileostomi, hartman prosedürü, total kolektomi toplam üç hastaya uygulandı. Üç hasta takiplerde kaybedildi. Sonuçlar: Ogilvie sendromu özellikle yatalak ve yandaş hastalıkları olan yaşlı hastalarda ciddi morbidite ve mortaliteye sebep olmaktadır.

Does Ogilvie’s syndrome cause significant morbidity and mortality in older patients?

Aim: Ogilvie syndrome is a disease characterized by acute, massive colonic dilation. It has significant morbidity and mortality. We analyzed the patients who had been treated and followed up with the diagnosis of Ogilvie syndrome. Material and Method: The patients with the diagnosis of Ogilvie syndrome treated in between April 2010 and July 2011 were analyzed retrospectively. Patient’s age, sex, preoperative symptoms, physical examination findings, co-morbidities, laboratory and radiological findings, management results were documented. The results were demonstrated as mean±SEM. Statistical analysis was performed in SPSS 17 program. Results: Five (5) patients had been managed in study period. There were 3 men and 2 women. The mean age was 71.4±12 (range:50-79). The duration of symptoms was 1-5 days. The most common symptom was abdominal pain (4 patients). Five patients were treated medically measures. Neostigmine was used in three patients. Two of these patients were operated. İleostomy, hartman precedure and total colectomy were surgical operations. There were three mortality. Conclusion: Ogilvie syndrome has significant morbidity and mortality specially in immobile,older patients with co-morbidities.

PDF

___

1. Ogilvie WH. Large-intestine colic due to sympathetic deprivation. Br Med J 1948;2: 671–3.
2. Mashour GA, Peterfreund RA. Spinal anesthesia and Ogilvie’s syndrome. J Clin Anesth 2005;17:122-3.
3. Choi JS, Lim JS, Kim H, Choi JY, Kim MJ, Kim NK, et al. Colonic pseudo-obstruction: CT findings. AJR Am J Roentgenol 2008;190:1521–6.
4. Rex DK. Colonoscopy and acute colonic pseudo-obstruction. Gastrointest Endosc Clin N Am 1997;7:499-508.
5. Johnson CD, Rice RP, Kelvin FM, Foster WL, Williford ME. The radiologic evaluation of gross cecal distension: emphasis on cecal ileus. AJR Am J Roentgenol 1985;145:1211-7.
6. Saunders MD. Acute colonic pseudo-obstruction. Best Pract Res Clin Gastroenterol 2007;21:671-87.
7. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum 1986;29:203-10.
8. Rovira A, López A, Cambray C, Gimeno C. Acute colonic pseudoobstruction (Ogilvie's syndrome) treated with erythromycin. Intensive Care Med 1997;23:798.
9. Mazloum BW, Barnes JB, Lee M. Cisapride as a successful treatment for acute intestinal pseudo-obstruction. South Med J 1996;89: 828-30.
10. White L, Sandhu G. Continuous neostigmine infusion versus bolus neostigmine in refractory Ogilvie syndrome. Am J Emerg Med 2011;29: 576.e1-3.
11. Paran H, Silverberg D, Mayo A, Shwartz I, Neufeld D, Freund U. Treatment of acute colonic pseudo-obstruction with neostigmine. J Am Coll Surg 2000;190:315-8.
12. Law NM, Bharucha AE, Undale AS, Zinsmeister AR. Cholinergic stimulationenhances colonic motor activity, transit, and sensation in humans. Am J PhysiolGastrointest Liver Physiol 2001;281:G1228-37.
13. Aquilonius SM, Hartvig P. Clinical pharmacokinetics of cholinesterase inhibitors. Clin Pharmacokinet 1986;11:236-49.
14. Stephenson BM, Morgan AR, Salaman JR, Wheeler MH. Ogilvie's syndrome: a new approach to an old problem. Dis Colon Rectum 1995;38: 424-7.
15. Trevisani GT, Hyman NH, Church JM. Neostigmine: safe and effective treatmentfor acute colonic pseudo-obstruction. Dis Colon Rectum 2000;43: 599-603.
16. Tenofsky PL, Beamer L, Smith RS. Ogilvie syndrome as a postoperative complication. Arch Surg 2000;135(6):682-6; discussion 686-7.
17. Nelson JD, Urban JA, Salsbury TL, Lowry JK, Garvin KL. Acute colonic pseudo-obstruction (Ogilvie syndrome) after arthroplasty in the lower extremity. J Bone Joint Surg Am 2006;88:604-10.
18. Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acute colonic pseudo-obstruction. Gastrointest Endosc 1996;44:144–50. B. Kaya ve ark.