The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients.
Aged; Aged, 80 and over; Cecum; Cholinesterase Inhibitors; Colonic Pseudo-Obstruction; Female; Humans; Ileostomy; Intestinal Perforation; Intestinal Pseudo-Obstruction; Laparotomy; Male; Minimally Invasive Surgical Procedures; Neostigmine; Organ Size; Postoperative Complications; Radiography, Abdominal; Retrospective Studies; Spinal Fusion; Tomography, X-Ray Computed
BACKGROUND: Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies.
METHODS: Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded.
RESULTS: Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy.
CONCLUSION: Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair.
Neurosciences (Brain & Spine)
Januszewski, Jacob; Keem, Sean K; Smith, William; Beckman, Joshua M; Kanter, Adam S; Oskuian, Rod J; Taylor, William; and Uribe, Juan S, "The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients." (2017). Articles, Abstracts, and Reports. 2422.