On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (Live and Virtual)| September 2026-Sharda

Sharda_Ogilvies and Volvulus Management

Pdf Summary

This presentation reviews endoscopic and procedural management of large-bowel obstruction syndromes, focusing on intussusception, sigmoid volvulus, and acute colonic pseudo-obstruction (ACPO/Ogilvie’s syndrome), with brief mention of cecal volvulus.

<strong>Colonic intussusception</strong> is described as telescoping of one bowel segment into another. It is rare, usually has a lead point, and carries a high malignancy risk (about 70%), so <strong>surgical en bloc resection</strong> is generally recommended, though endoscopic evaluation may be attempted before surgery if there is no complete obstruction.

<strong>Sigmoid volvulus</strong> is explained as torsion of the sigmoid colon on its mesentery and is a major cause of large-bowel obstruction, especially in patients with risk factors such as advanced age, chronic constipation, neurologic disease, immobility, diabetes, and psychiatric disease. Endoscopic detorsion and decompression are emphasized, with practical tips including minimal insufflation, possible unsedated or water-immersion technique, and gentle torque. The talk highlights the importance of assessing mucosal viability and leaving a decompression tube when possible. Several tube options are reviewed, including commercial decompression tubes and repurposed devices such as red rubber catheters, Malecot tubes, Blake drains, and chest tubes. For frail patients who are poor surgical candidates, <strong>percutaneous endoscopic sigmoidopexy/colopexy</strong> may be considered, though recurrence and complications are concerns.

<strong>ACPO (Ogilvie’s syndrome)</strong> is discussed as a functional colonic dilation seen in elderly, postoperative, immobile, or neurologically impaired patients, often worsened by electrolyte abnormalities. Management includes correcting reversible causes, <strong>neostigmine</strong> administration with monitoring, and endoscopic decompression with a decompression tube left in place if possible. Off-label longer-term options such as <strong>pyridostigmine, prucalopride, methylnaltrexone, and PEG</strong> are mentioned. Percutaneous endoscopic cecostomy is presented as an option in selected cases.

The main take-home message: <strong>decompression is key, larger-bore tubes clog less, adjunct medications may help in ACPO, and surgery remains essential when ischemia or nonviable bowel is present.</strong>

Keywords

colonic intussusception

sigmoid volvulus

acute colonic pseudo-obstruction

endoscopic decompression

large-bowel obstruction

neostigmine

surgical resection

decompression tube

percutaneous endoscopic colopexy

cecal volvulus