Does your stomach feel like it's turning into stone? Let's learn about this rare condition (Ogilvie Syndrome)

Have you ever felt like something was stuck in your stomach, your stomach was getting bigger, and you were feeling like it was going to explode? It was like your intestines were completely blocked. Usually, that happens when something is actually blocked in your intestines. However, there is a strange and rare condition where your intestines suddenly stop working without anything being stuck inside. Today, we are going to talk about a condition that most people have never heard of. In medical terms, we call this Ogilvie Syndrome or Acute Colonic Pseudo-obstruction (ACPO) .

Simply put, what is Ogilvie Syndrome?

Imagine, there is a lot of traffic, but there are no accidents or obstacles on the road. The vehicles are just standing still. Ogilvie Syndrome is something like that. The movement of food and waste inside your colon suddenly stops. It feels like something is stuck in your colon, but there is actually no physical obstruction. The problem lies in the nervous system that controls the muscles in your colon. Because it doesn't work properly, the movement of the colon (we call this ``peristalsis``) stops, and the contents inside get stuck in one place. This causes the colon to gradually dilate, or bulge.

The word ``pseudo-obstruction'' in its name means ``false obstruction.'' This means that it presents symptoms as if there is an obstruction, even though there is actually no obstruction.

How is this different from other intestinal problems?

There are different conditions that impair intestinal function. So let's see how Ogilvie Syndrome differs from them.

• Compared to other `Intestinal Pseudo-obstruction` conditions: Ogilvie Syndrome is an `acute` condition. That is, it comes on suddenly, and is temporary . And it only affects the large intestine . However, some people can have `chronic` `pseudo-obstruction` conditions. They are usually caused by another chronic disease or a congenital condition.
• The difference with `Paralytic Ileus`: You may have heard the term `Paralytic Ileus`. It is used to describe a condition where the intestines stop working for a while, especially after abdominal surgery. It is very common. It involves both the small and large intestines temporarily stopping functioning and then healing on its own within a few days. However, Ogilvie Syndrome is a more complex and rare condition . It mainly affects the large intestine , specifically the cecum.

Who is most at risk of developing this condition?

Although it can occur in anyone, it is most common in older people over the age of 60 who have other health problems . It occurs in about one in 1,000 hospitalized patients.

Simply put, this can happen anytime the body is under a lot of stress. Think of a major surgery, a serious accident, a heart attack, or a severe infection. These things affect the functioning of our nervous system. This nervous system is what tells the muscles in the intestines to "move." So when there is an imbalance there, the intestines stop working and Ogilvie Syndrome can occur.

What are the symptoms of Ogilvie Syndrome?

When air, fluid, and undigested food become trapped in your intestines, you may experience symptoms like these. These may start suddenly and gradually increase.

Why does this happen? Let's take a deeper look at the reasons.

Although the exact cause of this is still not 100% clear, scientists believe that it is caused by a malfunction in our autonomic nervous system . Think about it, the things that happen automatically in our body, such as heartbeat, breathing, and digestion, are controlled by this nervous system, which works like an ``auto-pilot.'' So, due to a lot of stress on the body, this ``auto-pilot'' system can be out of balance, and the signals that control bowel movements can be disrupted.

The main reasons that contribute to this situation can be divided into several categories.

Can this be serious? What are the complications?

Yes, if this is not diagnosed and treated properly, it can lead to very serious and even life-threatening complications . Imagine, what happens if you keep blowing air into a balloon? It bursts. The intestines are the same way.

The normal diameter of the large intestine is about 8 centimeters. However, in Ogilvie Syndrome, if it becomes larger than 12 centimeters, the risk of complications is much higher.

The main complications that can occur are:

• Ischemia: Excessive stretching of the intestinal walls causes the delicate blood vessels that supply blood to them to become constricted, reducing blood supply . This causes inflammation of the intestine (ischemic colitis), which, if left untreated, can lead to tissue death (necrosis).
• Perforation: When tissue dies, the intestinal wall weakens and a small hole can form . This is very dangerous because germs and waste products from the intestine can leak into the abdominal cavity, causing a serious infection (peritonitis).
• Sepsis: An infection that has spread to the abdominal cavity does not stop there. It can enter the bloodstream and spread throughout the body . This is a life-threatening condition that requires emergency medical treatment. It can even lead to organ failure.

How to accurately diagnose this disease?

Doctors are mainly concerned with two things when diagnosing this disease.

1. First, we check whether there is actually a physical obstruction in the intestine.

2. If there is no such obstruction, it is determined whether the cause of these symptoms is Ogilvie Syndrome or something else.

Various tests are being conducted for this.

• X-rays and CT scans: An abdominal X-ray or CT scan can clearly show the large intestine, which is swollen and filled with air. Sometimes, a special liquid (a `contrast agent`) is given to drink or as an injection to get clearer images.
• Gastrografin Enema: This is a very special test. Because it is both a test and sometimes a treatment. Here, a water-soluble liquid called `gastrografin` is inserted into the intestine through the rectum, and the way it moves along the intestine is watched with a video X-ray `(fluoroscopy)`. This can accurately determine whether there is an obstruction in the intestine or not. Also, this `gastrografin` liquid has laxative properties. Therefore, sometimes its effect helps to restart the activity of the intestine that has stopped.

What are the treatments for this?

Treatment depends on how bloated your colon is and whether you are at risk for complications. Whenever possible, doctors try to treat it with simple supportive treatments (`conservative treatment`) rather than resorting to things like surgery.

Conservative Treatment

Initially, this treatment is performed while carefully monitoring the patient's condition.

• Treating underlying conditions: If there is an underlying condition, such as an infection or heart disease, that is treated first.
• Stopping medication: Medications suspected of causing Ogilvie Syndrome are temporarily stopped.
• Resting the bowel: Completely stopping oral food and fluids.
• IV Saline: The body's required amount of fluids and salts is given through a vein (IV fluids).
• Walking and changing positions: If possible, encourage the patient to walk around a bit and change positions in bed. This can stimulate bowel movements.
• Intubation: A tube (`Nasogastric tube`) is inserted through the nose into the stomach to remove excess air and fluid. A tube (`Rectal tube`) is also inserted through the anus to allow air to escape.

During this treatment, doctors regularly perform X-rays and blood tests to monitor the condition of the intestines and any complications.

What if supportive treatment is not successful?

If the condition does not improve after about 72 hours, or if the intestine is more than 12 centimeters dilated, the doctors will move on to the next step.

• Colonoscopic Decompression: In this, a tube with a camera attached (a `colonoscope`) is inserted through the anus and the air that has accumulated in the colon is sucked out through the tube. This immediately reduces the pressure in the colon. However, since this is a somewhat uncomfortable procedure and sometimes there is a small risk of perforation of the colon, it is done with great care.
• Neostigmine Injection: This is a very powerful muscle stimulant. It is usually used to help muscles recover after anesthesia. When this drug is given as an intravenous (IV) injection to people with Ogilvie Syndrome, the intestinal muscles start working again, and good results have been obtained. However, because this drug can cause a very slow heart rate, it is only given under the close supervision of a doctor in the intensive care unit (ICU) .
• Surgery (Colectomy / Colostomy): If, despite all these treatments, the bowel continues to swell, or if a serious complication such as a perforation occurs, surgery may be the last resort. In this case, the damaged part of the bowel is cut out and removed (Colectomy). Sometimes, a temporary or permanent opening in the abdomen needs to be made to allow stool to pass through. We call this a Colostomy.

Can this condition be life-threatening?

Without complications, the risk of death for someone with Ogilvie Syndrome alone is about 15%. However, this percentage also includes the effects of other medical conditions the patient has.

However, if a serious complication such as intestinal perforation occurs, the mortality rate is as high as 40%. This shows how serious this condition can be.

The most important thing is to pay attention to the symptoms as soon as they appear, diagnose the disease quickly, and start treatment. If you do, you can prevent serious complications and recover quickly with simple treatments.

Ogilvie Syndrome, acute colonic pseudo-obstruction, bowel function, bloating, colon, abdominal pain, intestinal obstruction