What is the treatment of choice for colonic pseudo-obstruction (Ogilvie's syndrome)?

• A. Immediate Surgical Resection
• B. Laxatives and Stool Softeners
• C. Neostigmine With Colonic Decompression
• D. Antibiotics

Answer: (C)

Ogilvie's syndrome is a functional, not mechanical, obstruction of the colon, so the goal is to rapidly stimulate colonic motility and relieve distension while ruling out perforation or ischemia. The treatment of choice is to administer neostigmine, a cholinesterase inhibitor, which increases acetylcholine in the gut and triggers strong colonic contractions. This pharmacologic decompression often works quickly, but it requires careful monitoring because it can cause bradycardia or hypotension; atropine should be ready to treat these effects, and the patient should be in a setting where continuous monitoring is available.

If the response to neostigmine is incomplete or if endoscopic access is preferred or needed, colonic decompression via colonoscopy can be performed to physically relieve the distension. Surgery is reserved for cases with perforation, ischemia, or failure of nonoperative measures.

Laxatives, stool softeners, or routine antibiotics don’t address the underlying functional obstruction and aren’t appropriate as primary treatment.