Presentation
Transferred after prior CT in a different institution showed paralytic large bowel ileus. Extreme meteorism and increased bowel sounds upon physical examination. Generalized abdominal dyscomfort. Infrequent but retained bowel movements.
Patient Data
Extremely distended colon with wide air-fluid levels.
Extreme, uniform colonic distention with air-fluid levels, but no transition point, suggestive of colonic pseudo-obstruction. Tiny locules of subcutaneous air.
Other: gallstones, diverticulosis, signs of prior injury (pyelonephritis?) in the right kidney, kidney cyst
The condition of the patient remained stable under conservative management, but no underlying (e.g. metabolic) cause was identified, and colonoscopy also revealed no major abnormality either.
A colonic transit study was initiated. 6 hours after the ingestion of the radioopaque markers most are already in the region corresponding to the terminal ileum-cecum. The colonic distention shows no improvement.
24 hours after the ingestion the position of the markers shows only minimal change, and are mostly in the cecum-ascending colon.
Three days after ingestion all of the 10 ingested markers are still in the colon, indicating a severe impairment of colonic motility. Some of the markers have reached the descending and sigmoid colon.
The colonic distention shows no improvement, some of the markers ingested 12 days earlier are still in the region corresponding to the sigmoid colon.
Case Discussion
The findings are in line with colonic pseudo-obstruction (Ogilvie syndrome) with no mechanical cause. Conservative management proved to be futile, and the patient received a decompressing sigmoidostomy after which the symptoms gradually improved, and was subsequently discharged.
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