Getting stuck on a name: An example of an eponymous syndrome

Figure 1

Image of title page of Heneage Ogilvie's seminal article describing colonic pseudo-obstruction (or Ogilvie syndrome).

In this issue of the Journal, Ali et al² present a reminder about colonic pseudo-obstruction with images of a patient with Ogilvie syndrome. There has been ongoing debate in the medical academic and publishing communities about whether to continue using eponymous diagnostic nomenclature or shift entirely to an anatomic or pathophysiologic descriptive terminology. Although this discussion was started more than a century ago, focus on the topic has increased over the past 2 decades.^3,4

An ethically driven approach to this issue has been to consider the eponymous terms individually, expunging terms linked to individuals who are viewed historically as having behaved in humanistically and professionally unacceptable ways and avoiding terms linked to groups or countries in ways that are unnecessarily demeaning. Examples of the former are stripping the honor of syndrome-associated eponyms from Nazi physicians Reiter and Wegener.⁵ A broader, heuristically based argument for eliminating all eponymous terms is that their usage requires trainees to learn terms that have no relation to the actual diagnosis or anatomy.⁶ This approach has seemingly had less acceptance.

I am a (dabbling) fan of medical history, and I believe that there is value in staying grounded with our intellectual and clinical past in order to maintain our professional group identity. There is value in knowing where we came from professionally, taking pride in the intellectual process and accomplishments of physicians who came before us. There should be more to our academic professional tapestry than performance metrics and an ability to argue for insurance prior authorization. We should strive to maintain connections to our professional and academic past above and beyond the gestures of medical school White Coat Ceremonies and reciting the Hippocratic Oath. While I totally applaud efforts to avoid granting enduring name recognition to those with truly reprehensible behaviors that besmirch our profession, I believe that we should continue to recognize and honor the intuitive and empiric insights of individual clinicians who have contributed to the growth of knowledge that frames our practice of medicine. Their stories deserve retelling. Plus, not to be ignored are the historical ironies of the deaths of Dr. Armand Trousseau (gastric cancer associated with thrombophlebitis) and Dr. John Hageman (pulmonary embolism on a background of factor XII deficiency) given their eponymous associations with syndrome and coagulation factor.

A nuance of maintaining eponymous connections is that, over time, named syndromes may morph from the way they were first described or interpreted. Ogilvie,¹ in a delightfully conversational way, described 2 patients with apparent colonic obstruction in the absence of abnormalities on barium imaging. At exploratory laparotomy, he found extensive and unexpected malignant disease “involving the region of the crura of the diaphragm and the coeliac axis and semilunar ganglion” without direct engagement of the colon. The pathologic diagnoses were cancer of the pancreas and adenocarcinoma of undetermined origin. Ogilvie proposed that direct invasion of the mesenteric nerves selectively blocked the sympathetic flow to the colon, leaving the parasympathetic flow unfettered. Since then, most patients with Ogilvie syndrome described in the literature have not had direct invasion of the mesenteric nerves by cancer, yet the pathophysiologic premise for the syndrome has persisted. Fast forward to 1999 when Ponec et al⁷ discussed the use of neostigmine to treat acute colonic pseudo-obstruction by reversing the presumed parasympathetic-sympathetic imbalance.

Ogilvie syndrome is not common but is important to recognize. There is undoubtedly a spectrum of severity. Patients may be admitted to the hospital with it, but it seems to occur more frequently in the hospital after acute surgeries in older patients (mainly spine or orthopedic procedures) or after cesarian section, acute central nervous system events (stroke, subdural hematoma, or tumor), or acute severe medical illness. The only patient with Ogilvie syndrome I have personally encountered—other than multiple patients with systemic sclerosis, which likely has a distinct pathophysiology—had been admitted with severe pneumonia.

In a retrospective review of 48 patients diagnosed with Ogilvie syndrome over an 11-year period, Haj et al⁸ reported the details of 37 patients. Nine patients had preceding orthopedic surgery, while 10 had been admitted with an acute neurologic diagnosis. The average age was 67, and 27 patients were male. The pseudo-obstruction had been managed conservatively (nasogastric tube, rectal tube, or both) or interventionally with neostigmine, decompressive colonoscopy, or surgery. In this nonrandomized series, those treated conservatively or interventionally had similar overall outcomes: complications were mild and more common in the intervention group (61% vs 21%). The mean time to resolution in both groups was 5 days, with an overall recurrence rate of 24%.

So, although it could be argued that the use of eponymous terms in medicine represents an unnecessary incorporation of trivia into our lexicon, I enjoy at least occasionally maintaining the connection with our profession’s past.

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