Learning Radiology xray montage

Colonic Pseudo-obstruction
Ogilvie Syndrome, Colonic Ileus

General Considerations

  • Mimics large bowel obstruction without point of obstruction
  • Mostly in those over 60, with a slight male predominance
  • Apparently due to autonomic nervous system imbalance leading to a dysfunctional distal colon and colonic ileus similar to Hirschsprung’s disease
  • The cecum, having the largest resting diameter to start, is the most easily dilated (Laplace law)
  • Can lead to ischemic of bowel and perforation

Clinical Findings

  • Usually associated with other serious medical conditions such as trauma (including recent surgery), systemic infection, electrolyte imbalance, malignancy, medications with an anti-cholinergic effect, and cardiovascular disease
  • Abdominal pain, distension and tenderness
  • Nausea and vomiting
  • Obstipation
  • Fever
  • Bowel sounds can be normal or hyperactive in about 40%

Imaging Findings

  • Plain films of the abdomen are the study of choice
  • Colon is dilated
  • May have multiple, long fluid levels
  • The cecum should not exceed 12-15 cm in diameter due to risk of perforation
  • CT is helpful in excluding a cause of a large bowel obstruction or perforation

Differential Diagnosis

  • Large bowel obstruction
    • No point of obstruction in colonic pseudo-obstruction
  • Constipation
  • Megacolon
  • Mesenteric ischemia


  • Treat any underlying medical conditions
  • Rectal tube decompression
  • Colonoscopic decompression
  • Medications such as Neostigmine
  • Rarely, surgical decompression such as cecostomy


  • Can lead to ischemic of bowel and perforation


  • Mortality rates originally reported as high as 50% have fallen with pharmacologic management 

ogilvie syndrome

Ogilvie Syndrome. Images are supine and upright radiographs of abdomen which show dilated colon from cecum to rectum with multiple air-fluid levels.
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eMedicine. Ogilvie Syndrome. P Remy, MD; K Kumbum, SL Carpenter and B Holmstrom