An intestinal pseudo-obstruction feels like something is physically blocking your bowels. But they aren’t actually obstructed — they’re paralyzed. Ogilvie syndrome is an acute type of colonic pseudo-obstruction. It occurs suddenly, often after an illness, injury or surgery.
Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a sudden and unexplained paralysis of your colon. Your colon acts like it’s blocked or obstructed by something (pseudo-obstruction) but nothing is physically obstructing it. The problem is in your colon’s motor system. It stops moving food along, allowing it to build up inside and causing the walls to dilate (widen).
Ogilvie syndrome is an acute condition — which means it’s sudden and temporary — and it only affects your colon, otherwise known as your large intestine. “Intestinal pseudo-obstruction” is more of an umbrella term that refers to any paralysis of your intestines that’s not caused by a mechanical obstruction. Some people have chronic intestinal pseudo-obstruction due to a chronic disease or congenital (present from birth) condition.
Paralytic ileus is an acute type of intestinal pseudo-obstruction that typically affects both intestines. It’s very common after abdominal surgery, when your bowels are just a little slow to start working again. It usually resolves on its own in a few days. Ogilvie syndrome affects your colon, specifically — usually right at the start of it (your cecum). It’s uncommon and tends to be more complex than paralytic ileus.
Although it can happen to anyone, Ogilvie syndrome most often affects older adults with multiple underlying health conditions. Surgery, trauma, cardiovascular disease or severe infection can trigger it. Electrolyte imbalances, neurological diseases and taking multiple medications are all risk factors. These factors all affect your nervous system, which is what tells your colon muscles to move food along.
About 1 in 1,000 hospital admissions report Ogilvie syndrome. The average age of people affected is 60.
When partially digested food and gas begin to build up in your colon, you might experience:
The exact cause isn’t fully understood, but scientists believe it results from a dysfunction of your autonomic nervous system. This is the part of your nervous system that controls the involuntary muscle movements that regulate your bowels (peristalsis). Since it’s an acute condition, some unusual stress on your autonomic nervous system probably triggers it. But other health factors also probably contribute.
Acute medical conditions that have been known to trigger Ogilvie syndrome include:
Preexisting health factors that may contribute to Ogilvie syndrome include:
Medications that have been associated with Ogilvie syndrome include:
Ogilvie syndrome often resolves on its own or with supportive care. But sometimes it does need intervention. If it goes unrecognized for too long and continues to worsen, it can cause some serious complications. Studies suggest that complications are more likely to occur when your colon is dilated wider than 12 cm. The normal diameter is 8 cm.
The risk increases as dilation increases. Risks include:
Diagnosis depends on:
To see the inside of your colon in detail, healthcare providers use a type of imaging that combines radiology with an internal contrast agent. The contrast material coats the inside of your colon to make features stand out better in black and white. You may swallow the contrast, or you may receive it through an enema or IV. Contrast CT scan and contrast fluoroscopy are two methods providers use.
One test, called a gastrografin enema, may even double as a treatment. It involves injecting a water-soluble contrast solution called gastrografin into your colon through your rectum and then taking fluoroscopic X-rays. (Fluoroscopy is a type of video X-ray that tracks the solution as it travels through.) As a side effect, gastrografin may act as a laxative in your colon and may help get it moving again.
Treatment depends on how dilated your colon is and whether you appear to be at risk of complications. When possible, healthcare providers treat Ogilvie syndrome conservatively with supportive care and close observation. But when necessary, they’ll intervene with medications or procedures to decompress your colon and reduce the risk of complications. If complications arise, they’ll require urgent care.
Conservative treatment may include:
If you’re already dilated more than 12 cm, or if conservative treatment hasn’t worked after 72 hours, your healthcare provider may want to intervene to help relieve your colon.
Complications can be fatal. The mortality rate with complications, such as perforation or ischemia, is up to 40%. But less than 15% of people develop these complications. Without complications, the mortality rate for Ogilvie syndrome is closer to 15%. This rate probably doesn’t represent Ogilvie syndrome alone. Most people who develop Ogilvie syndrome have other health conditions affecting their mortality.
A note from Cleveland Clinic
An acute colonic pseudo-obstruction is an unexpected factor that can bring new complications for people already managing other health conditions. Nobody anticipates Ogilvie syndrome, but everybody should take the symptoms seriously. Early recognition is key to preventing the serious complications of Ogilvie syndrome. Without complications, it’s likely to resolve shortly with conservative treatment.
Last reviewed by a Cleveland Clinic medical professional on 03/08/2023.
Learn more about our editorial process.