Ogilvie Syndrome: Acute colonic pseudo-obstruction involves acute colonic dilation without a physical mechanical obstruction, commonly triggered by trauma, severe illness, or recent surgery [00:22 Opens in a new window ].
Complication Risks: Perforation occurs in 3–15% of cases (with ~50% mortality if perforated), and risk escalates significantly when the cecal diameter exceeds 12 cm [00:38 Opens in a new window ].
Standard Treatment Limits: Endoscopic decompression without placing a tube has a high recurrence rate of ~40% [01:25 Opens in a new window ]. Existing commercial decompression tubes are long and narrow, making them highly prone to clogging even with frequent flushing [01:45 Opens in a new window ].

Drain Choice: The authors demonstrate using a 24-French Blake drain, which provides a larger diameter, shorter length, and four continuous channels that allow multiple drainage points and resist clogging [03:07 Opens in a new window ].
Modification: An absorbable suture loop is attached to the proximal end (to anchor the tube to the colonic wall), while a non-absorbable loop is placed at the distal end (to prevent proximal migration) [03:21 Opens in a new window ].
Insertion & Anchoring:
1. A 25 mm snare grasps the proximal end of the Blake drain through the endoscope [03:49 Opens in a new window ].
2. The endoscope and drain are advanced together into the colon up to the hepatic flexure [04:03 Opens in a new window ].
3. A 16 mm endoscopic clip attaches the absorbable suture loop to the colon wall [04:20 Opens in a new window ].
4. The external portion (~5 cm) is taped to the patient's gluteal area and attached to a gravity collection bag [05:07 Opens in a new window ].

Patient Case: In a 63-year-old patient with decompensated cirrhosis whose cecal diameter expanded to 17 cm despite previous standard tube placement [02:34 Opens in a new window ], this technique reduced cecal diameter to 9.5 cm [05:24 Opens in a new window ].
Resolution: Symptoms improved within 24 hours, the patient passed the tube spontaneously 1 day post-procedure, and was safely discharged [05:32 Opens in a new window ]. The technique has since been replicated successfully in additional cases of pseudo-obstruction and sigmoid volvulus [05:47 Opens in a new window ].