Acute colonic pseudo-obstruction (Ogilvie's syndrome), lower limb arthroplasty and opioids

Opioid analgesic agents remain the first choice for common treatment of severe pain following major orthopaedic surgery. The common adverse effects of these drugs include nausea, sedation, pruritis and respiratory depression. In addition opioids have also been associated with some unpredictable severe adverse effects which may occasionally be life threatening. One such complication is acute colonic pseudo-obstruction (ACPO) or Ogilvie's syndrome. ACPO is a potentially fatal condition characterized by clinical and radiographic appearances of colonic obstruction in the absence of an anatomically obstructing lesion. This complication may be more common than previously reported and although opioid analgesics have been implicated as the major cause many other factors can also predispose to colonic pseudo-obstruction. We review the aetiology, pathophysiology, predisposing factors, treatment and prevention of acute colonic pseudo-obstruction after lower limb arthroptasty. The opioids implications in aetiology of the acute colonic pseudo-obstruction will be also discussed.