A 65yr man who is hospitalized with pancreatic carcinoma

Discussion in 'MRCS Forum' started by Smarti., May 27, 2008.

  1. Smarti.

    Smarti. Guest

    A 65-year-old man who is hospitalized with pancreatic carcinoma develops abdominal distension and obstipation. The following abdominal radiograph is obtained. Appropriate management is best achieved by -

    a- Urgent colostomy or cecostomy
    b- Discontinuation of anticholinergic medications and narcotics and correction of metabolic disorders
    c- Digital disimpaction of fecal mass in the rectum
    d- Diagnostic and therapeutic colonoscopy
    e- Detorsion of volvulus and colopexy or resection
  2. Smarti.

    Smarti. Guest

    Answer: d. (Greenfield, 2/e, pp 1092-1093) As classically described, Olgilivie syndrome was associated with the rare occurrence of malignant infiltration of the colonic sympathetic nerve supply in the region of the celiac plexus. The eponym is now applied to the condition in which massive cecal and colonic dilation is seen in the absence of mechanical obstruction. Other terms use to describe this condition are acute colonic pseudo-obstruction, colonic ileus and functional colonic obstruction. It tends to occur in elderly patients in the setting of cardiopulmonary insufficiency, in other systemic disorders that require prolonged bed rest, and in the postoperative state. The diagnosis of Olgilvie syndrome cannot be confirmed until mechanical obstruction of the distal colon is excluded by colonoscopy or contrast enema. Anticholinergic agents and narcotics need to be discontinued, but any delay in decompressing the dilated cecum is inappropriate since colonic ischemia and perforation become a distinct hazard as the cecum reaches this degree of dilation. Cautious Endoscopic colonic decompression has been demonstrated recently to be a safe and effective form of treatment. Endoscopy should be combined with rectal tube placement, correction of metabolic abnormalities, and discontinuation of medications that diminish gastrointestinal motility. The high complication rate in this population notwithstanding, a direct surgical approach to decompression becomes necessary when colonoscopic decompression fails; a perforated cecum is a catastrophic event in such patients.

Share This Page