Pseudoobstrucción colónica aguda (Sindrome de Ogilvie) posterior a una nefrectomía radical: Reporte de caso

Resumen

El Sindrome de Ogilvie se caracteriza por una dilatación masiva del colon y una clínica sugestiva de obstrucción intestinal mecánica, sin causa orgánica. Presentamos un caso de dilatación aguda idiopática del colon secundaria a una cirugía abdominal.

El objetivo de este reporte fue la descripción de una patología urológica inusual que puede pasarse por alto o tratarse como un íleo adinámico y, la revisión de la literatura relacionada con la definición, factores de riesgos, etiología, fisiopatología y el tratamiento de la misma.

Paciente masculino de 61 años con antecedente de nefrectomía radical izquierda por tumor renal que, a las 48hs del alta hospitalaria, consultó por presentar distensión abdominal aguda. Se solicitó una radiografía abdominal y una tomografía computada que evidenciaba importante dilatación intestinal y un diámetro cecal mayor a 12cm.

Se practicó una laparotomía exploradora de urgencia constatándose dilatación colónica del colon transverso y ascendente con un cambio de diámetro a nivel del ángulo esplénico, sin causa osbtructiva. Finalmente, se realizó colostomía en asa.

A los 6 meses de seguimiento, la videocolonoscopía no mostró lesiones endoluminales concluyendo en un Sindrome de Ogilvie secundario a la nefrectomía. Finalmente, se efectuó reconstrucción del tránsito con buena evolución posterior.

En nuestro caso, el Sindrome de Ogilvie fue una complicación postoperatoria y como fallaron las terapias conservadoras iniciales instauradas, este reporte provee una modalidad de tratamiento alternativo. Si se reconoce temprano y se trata adecuadamente, la pseudoobstrucción se resolverá en la mayoría de los pacientes y la tasa de mortalidad posterior será menor.

Abstract

Ogilvie's Syndrome is characterized by massive dilation of the colon and symptoms suggestive of mechanical intestinal obstruction, without organic cause. We present a case of acute idiopathic dilation of the colon secondary to abdominal surgery.

The aim of this case report was the presentation of an unusual pathology that can be overlooked or treated as adynamic ileus and the review of the literature addressing the definition, risk factors, etiology, pathophysiology and treatment of it.

A 61-year-old male patient with a history of a left radical nephrectomy due to a renal tumor. At 48hs after from his hospital discharge, he consulted for presenting acute abdominal distension. An abdominal radiograph and a computed tomography scan showed evidence of dilated loops of bowel with caecal diameter more than 12 cm.

An emergency laparotomy was performed with an evidence of ascending and transverse colon distension with diameter change at a splenic angle level, it showed no apparent cause. The surgical procedure ends with a loop transverse colostomy.

At 6 months of follow up, the colonoscopy control did not show endoluminal injuries, we can infer a secondary Ogilviés syndrome to nephrectomy. Finally, the patient received a restoring intestinal and showed good progress.

In our case, Ogilviés syndrome was a postoperative complication and as the initial conservative therapies implemented failed, this report provides an alternative treatment modality. If recognized early and treated appropriately, pseudo-obstruction will resolve in most patients and the subsequent mortality rate will be minor.

Palabras Claves

pseudoobstrucción colónica - colostomía - neostigmina - tratamiento - nefrectomía

Keywords

colonic pseudo-obstruction - colostomy - neostigmine - treatment - nephrectomy

Publication History

Received: 22 July 2020

Accepted: 20 August 2020

Article published online:
26 October 2020

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