Research Day

Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) Leading To Respiratory Compromise And Death

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INTRODUCTION: When working with chronically developmentally disabled patients a wide range of comorbidities and social factors must be considered. Children with disabilities have an increased risk of abuse and neglect compared to those without disabilities, and individuals with intellectual disability have a two- to four-fold increased risk for polypharmacy.

MATERIALS AND METHODS: The materials in this report are from the files of one of the authors (JP).

CASE REPORT: A 19-year-old severely disabled man with cerebral palsy (CP) and autism experienced shortness of breath in association with a markedly distended abdomen, and subsequently died. Autopsy revealed significant distention of the small and large intestines, without any sign of perforation or obstruction. Also evident was severe upward compression of the diaphragm with associated pulmonary volume reduction. The cause of death was determined to be respiratory compromise secondary to diaphragmatic compression as a result of acute colonic pseudo-obstruction (ACPO), with contributing underlying factors of CP and autism, including possible medication mismanagement.

DISCUSSION: ACPO is characterized by colon distention without an apparent mechanism of mechanical obstruction. There are a number of conditions known to be associated with ACPO, and only 5.5 percent of reported cases are idiopathic. While there has not been a statistically proven association with cerebral palsy, cases have been reported. Treatment ranges from conservative measures such as cessation of contributing medications and administration of laxatives to surgical intervention.

CONCLUSION: This case serves to inform clinicians and pathologists about ACPO and its potential for being lethal, especially in severely disabled patients.

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