During recent years, we have witnessed many technological advances in electronic publication. The accessibility and wide diffusion of on-line publication will provide the opportunity for our scientific colleagues, not only in Latin America, but throughout the world, to share the knowledge and skills of our Mexican surgical community, as well as to provide authors from other countries with a forum for participating in our Journal, in order that we may gain knowledge of surgical specialties throughout the world. Manuscripts will be accepted in Spanish and in English, and will be translated to English or Spanish for on-line publication. Guidelines for manuscript submission can be accessed in this website. We are confident that this evolution in publication will serve the needs of the international community, as well as to provide our Mexican scientists with greater visibility throughout the global community. The Mexican Academy of Surgery is pleased to offer this on-line publication without fees or subscription.
|Published (Last):||7 February 2010|
|PDF File Size:||15.16 Mb|
|ePub File Size:||13.19 Mb|
|Price:||Free* [*Free Regsitration Required]|
The journal's production is being transferred to another publisher. If you want to submit a manuscript to the journal, please email it to bolmedhospinfantmex gmail.
The journal receives and publishes original articles in Spanish and in English relating to paediatrics in the following areas: biomedicine, public health, clinical epidemiology, health education and clinical ethics. The journal publishes the following articles types: original research articles, reviews, clinical cases, clinicopathological cases, paediatric themes, public health topics, letters to the editor, and editorial comments by invitation.
SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.
Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is a rare gastrointestinal syndrome in children. It is characterized by a marked dilatation of the colon evidenced by imaging and absence of mechanical obstruction. Patients typically present abdominal pain and distention, tympanic abdomen with peristalsis accompanied by nausea and vomiting.
This syndrome is very rare in pediatric patients, and no cases have been reported in a post-renal transplant pediatric patient.. A year-old male patient with a medical history of psychomotor retardation due to perinatal asphyxia and chronic renal failure secondary to bilateral renal hypoplasia was treated with peritoneal dialysis for one year until kidney transplantation.
Currently, he is under immunosuppressive regimen. His condition began with mild abdominal pain accompanied by semi-liquid stools, and progressive distention up to 78 cm of abdominal circumference in 72 hours. Image studies were performed. Managed with prokinetic drugs without any improvement.
Two exploratory laparotomies observed flanges, without evidence of any mechanical obstruction. An abdominal magnetic resonance was performed, where important intestinal dilatation was observed and no evidence of mechanical obstruction.
Ogilvie's syndrome was diagnosed, and management with neostigmine was initiated, which led to symptom resolution.. This syndrome is very rare in children. Therefore, there is little clinical suspicion and lack of management guidelines for diagnosis and treatment of patients of this age..
Se encuentra en manejo con inmunosupresores. Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome for being described by Ogilvie in , 1 is a gastrointestinal disorder characterized by a marked dilatation of the colon without a mechanical obstruction. In imaging studies, a dilatation of the colon without any signs of a mechanical obstruction can be observed. The mechanism by which this syndrome occurs is still unknown. The prevalent theory is that it is secondary to an imbalance of the autonomic innervation of the intestine, resulting in colonic atony.
Colonic pseudo-obstruction is a diagnosis of exclusion. Among the differential diagnosis, fecal impaction, colonic or rectal tumors, sigmoid or cecal volvulus and toxic megacolon should be considered. The initial treatment includes bowel rest, intravenous fluids, electrolyte imbalance correction, stopping the administration of drugs that affect intestinal motility and decompression with a nasogastric tube.
The next step is using neostigmine, a reversible acetylcholinesterase inhibitor that augments intestinal muscle contractility. Due to the rarity of this syndrome in pediatric patients and given that there are no reported cases of a pediatric post renal transplant, this case is important to the knowledge of this disease, to create management and treatment guidelines in pediatric patients.
A year-old male patient, without any relevant family history, with a perinatal history of a twin pregnancy, which was delivered by a cesarean section and that required advanced reanimation maneuvers presented with altered psychomotor development due to perinatal asphyxia, for which he receives neurodevelopmental therapy since the age of two years. At 11 years of age, he was diagnosed with chronic kidney disease caused by bilateral renal hypoplasia, which was treated with peritoneal dialysis until the age of 12 years.
The present illness started three weeks before his admission, with intermittent mild abdominal pain of a burning quality localized to the epigastrium and irradiation to the mesogastrium. No triggering or attenuating phenomena was present; accompanied by three to four stool depositions a day, with loose, semi-liquid stools of a greenish color, without any mucous or blood, and non-fetid. The pain became progressive, up until 24 hours before his admission, when it changed to moderate intensity, and incapacitating the patient, for which he attended the emergency unit.
Clinical examination revealed a globose abdomen, with a right flank scar, depressible, with tenderness on deep palpation in the epigastrium and mesogastrium. Without any signs of an acute abdomen, tympanic to percussion, with a conserved peristalsis in the four quadrants.
Complete blood count revealed anemia with a hemoglobin of Urinalysis was normal. Results of the biochemical profile showed creatinine: 0. Tacrolimus levels of 5. A contrast-enhanced abdominal tomography was performed, where only dilated intestinal loops and a kidney graft in a good state were observed.
A gastrointestinal transit was performed, which did not show any signs of obstruction. During the first days of in-hospital stay, the pain was managed with butylhyoscine. However, abdominal distention progressively increased.
Thus, a plain abdominal film was ordered, which showed air-fluid levels and intestinal distention Fig. A consultation with the adult surgery service was requested, which team was the same that participated in this patient's transplant, and they placed a nasogastric tube, which drained a fecaloid material. The patient was kept in observation with radiographic follow-up; nevertheless, he continued with pain and progressive abdominal distention of up to 78 cm of the abdominal perimeter.
An exploratory laparotomy was performed. This study revealed the presence of adhesions predominating at the level of the jejunum and ileum and a Meckel's diverticulum, which was resected and an anastomosis was performed. After surgery, the patient had hemodynamic instability and was transferred to the pediatric intensive care unit. An erect plain abdominal film. Significant distention of the small bowel intestinal loops and air-fluid levels.
In the intensive care unit, the patient was stabilized, although he continued with abdominal distention, which raised the suspicion of post-operatory ileus.
As the days went by and despite management with trimebutine, the pain and abdominal distention persisted without improvement. Therefore, the intestinal obstruction was suspected again. A second exploratory laparotomy was performed, in which adhesions and flanges were observed, without any signs of mechanical obstruction. A magnetic resonance enterography was performed in which an important dilatation of the small and large intestine was observed, with abundant fluid within, without any signs of mechanical obstruction Fig.
A consultation with pediatric gastroenterology was solicited, who suspected an acute colonic pseudo-obstruction, for which 1. Finally, an acute colonic pseudo-obstruction was diagnosed, for which two more doses of 1. During his hospital stay, the patient presented clinical improvement, with a progressive decrease in abdominal distention and symptoms, as well as a progressive improvement of oral intake.
The patient was discharged in a good clinical state. Magnetic resonance of the abdomen without contrast. Dilatation of the small and large intestine with abundant liquid and gas in its interior. Gas up to the zone of the rectum. No evidence of extraluminal fluid collections, or any signs of mechanical obstruction.
Ogilvie's syndrome is a very uncommon disorder in pediatrics; 2 it occurs in adult patients with severe cardiac, neurologic and respiratory diseases, as well as renal insufficiency, hypothyroidism, and disseminated cancer or surgical conditions.
Several medications have been related to Ogilvie's syndrome, among which vincristine, 1 opioids, 2 mycophenolate, 5 steroids, 4 calcium channel blockers 3 and anticholinergics, such as butylhyoscine 3 have been described. This patient has a history of renal transplantation and having received drugs such as mycophenolate and prednisone as risk factors. Trimebutine spasmolytic was also prescribed to the patient due to the antiserotoninergic activity, but there are no reports in the literature which associate this drug to acute colonic pseudo-obstruction.
Ogilvie's syndrome in post-renal transplant adult patients is well documented. In a retrospective study of renal-transplant patients, seven developed the syndrome acutely, and the literature showed that 78 patients developed the syndrome post-transplantation.
In adults, a tendency for an increased incidence in patients with chronic kidney disease has been observed due to certain factors such as aluminum antacid ingestion, inactivity, dehydration, electrolyte disorders and the use of high steroids doses.
Nevertheless, during surgery, flanges were observed without any signs of occlusion. Moreover, despite adhesiolysis, the patient's symptoms persisted. Imaging studies, including magnetic resonance and intestinal transit, did not reveal signs of obstruction either. After the laparotomies, a postoperative ileus was suspected.
Nevertheless, the days after surgery, the patient had normal peristalsis and evacuations, 9 and, given the lack of response to medical treatment with prokinetics such as clavulanate, erythromycin or cinitapride, a diagnosis of postoperative ileus was discarded. These data, additionally to an imaging study which showed a significant abdominal dilatation without any signs of obstruction, along with clinical resolution of the illness with neostigmine, confirmed Ogilvie's syndrome as the final diagnosis.
Neostigmine is a parasympathomimetic reversible acetylcholinesterase inhibitor, which is believed to increase colonic contractility by stimulating the parasympathetic nervous system. In some cases, patients can present symptomatic bradycardia that may require atropine, or bronchospasm, for which a cardiorespiratory surveillance may be necessary, with vital signs and electrocardiogram up to 30 minutes after drug infusion. In pediatric patients, the use of 0. In this patient, the maximal dose was nearly administered, 0.
An abdominal AP supine radiograph. A decrease of the colon dilatation and small bowel gas is observed, but liquid in the topography of the ascending colon and rectum persists. A nasogastric tube is observed at the level of the epigastrium. In the management of Ogilvie's syndrome, neostigmine has evidence of efficacy from multiple studies.
Given that Ogilvie's syndrome is infrequent, especially in pediatric patients, there is little clinical suspicion. Furthermore, an increased risk of multiple surgical procedures often unnecessary, or other failed treatments, long hospital stays, or in the worst case, complications of the disease such as ischemia, peritonitis or intestinal perforation, can be catastrophic in a transplanted patient with immunosuppression. Unlike adult patients, in which there is more information about this syndrome, in the pediatric age group, there is a need of clinical guidelines for the diagnosis and treatment.
Hence, the importance of reporting this case, since it is necessary to keep it in mind as a differential diagnosis, always striving for the benefit of the patient. The authors declare that no experiments were performed on humans or animals for this study. The authors declare that no patient data appear in this article.
The authors declare no conflict of interest of any nature. Bol Med Hosp Infant Mex. ISSN: Previous article Next article. Issue 4.
Colonic pseudo-obstruction also known as Ogilvie syndrome is a potentially fatal condition leading to an acute colonic distention without an underlying mechanical obstruction. It is defined as an acute pseudo-obstruction and dilatation of the colon in the absence of any mechanical obstruction. Numerous causes have been identified, and the demographics of affected patients generally reflect these, with elderly unwell patients being most frequently affected 4. Usually seen in people over 60 years of age and there is male predilection 5. Patients usually present with constipation, nausea, vomiting and abdominal distension.
2011, Number 1
Ogilvie syndrome is the acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients. Usually the patient has abdominal distention , pain and altered bowel movements. Ogilvie syndrome may occur after surgery, especially following coronary artery bypass surgery and total joint replacement. The exact mechanism is not known. The probable explanation is imbalance in the regulation of colonic motor activity by the autonomic nervous system.
Key words:. Acute colonic pseudo-obstruction. Br J Surg ; Rev Child Cir ; Rev Chil de Cir ; Dis Colon Rectum An Analysis of cases ; Bannura G, Portalier P.
The journal's production is being transferred to another publisher. If you want to submit a manuscript to the journal, please email it to bolmedhospinfantmex gmail. The journal receives and publishes original articles in Spanish and in English relating to paediatrics in the following areas: biomedicine, public health, clinical epidemiology, health education and clinical ethics. The journal publishes the following articles types: original research articles, reviews, clinical cases, clinicopathological cases, paediatric themes, public health topics, letters to the editor, and editorial comments by invitation. SRJ is a prestige metric based on the idea that not all citations are the same.