Ogilvie's syndrome: a case report

Appendiceal fat stranding on CT: a red herring in a post-caesarean section woman with Ogilvie's syndrome (OS)

A 30-year-old woman was referred for a surgical review with abdominal pain and distension 2 days post-caesearean section. Abdominal X-ray showed dilated bowel loops. CT of her abdomen however showed fat stranding around a thickened appendix, suggesting a differential diagnosis of acute appendicitis on top of a postoperative ileus. Failure to respond to intravenous antibiotics led to an emergent surgical exploratory laparotomy, by which time the progressive caecal dilatation had led to patchy necrosis and perforation of the right hemicolon intra-operatively. The patient required a right hemicolectomy and histological examination of the excised bowel supported the diagnosis of Ogilvie's syndrome. This case highlights the red herrings that one can encounter when faced with a woman with post-caesarean section abdominal pain and aims to raise awareness among clinicians of this condition-where timely diagnosis and management is key.

Acute colonic pseudo-obstruction: A systematic review of aetiology and mechanisms

AIM

To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO).

METHODS

A systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken.

RESULTS

No consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors.

CONCLUSION

Future research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.

Ogilvie's syndrome following caesarean section

Acute colonic pseudo-obstruction syndrome, also known as Ogilvie's syndrome, is a rare condition associated with significant morbidity and mortality. We report a case that developed very rapidly after emergency caesarean section. A 20-year-old woman underwent an emergency caesarean section for failure to progress in the first stage of labour and a healthy male infant was delivered without incident. However, soon afterwards the patient developed significant abdominal distension and pain. Ogilvie's syndrome was diagnosed following an abdominal x-ray which revealed a gross large bowel obstruction without mechanical cause. To prevent caecal rupture, the patient underwent successful emergency colonic decompression.

[Ogilvie's syndrome following cesarean section: Just think! Report of two cases and review of the literature]

OBJECTIVES

To identify clinical and radiological signs of the post-cesarean Ogilvie's syndrome in order to establish the appropriate treatment.

PATIENTS AND METHODS

Based on the Medline research, we listed 41 cases of Ogilvie's syndrome after cesarean section. We analyzed the patient's age, the clinical and radiological signs, the time to diagnosis, and the treatments and their efficiency.

RESULTS

The clinical signs generally appear in the first 72 h after cesarean. Diagnosis of Ogilvie's syndrome is based on a clinical picture of acute obstruction of the large bowel and by X-ray showing a large caecum without pathological lesion. If the caecal diameter is under 12 cm, conservative treatment is done with colonoscopic decompression when necessary, however if there are signs of peritonitis surgery is recommended.

CONCLUSION

Ogilvie's syndrome after cesarean section is uncommon. Diagnosis must be fast in order to avoid the caecum to burst causing faecal peritonitis, which carries slight mortality rate.

Ogilvie's syndrome with caecal perforation after Caesarean section: a case report

Introduction

Ogilvie's syndrome describes the phenomenon of an acute colonic pseudo-obstruction without a mechanical cause. It is rare but has been reported to occur after Caesarean section. It can lead to bowel perforation or ischaemia.

Case presentation

A healthy, 28-year-old Caucasian woman presented 2 weeks past her expected date of delivery for her first pregnancy. She underwent an uncomplicated elective Caesarean section but developed abdominal pain and bloating postoperatively and was subsequently diagnosed with acute colonic pseudo-obstruction, also known as Ogilvie's syndrome.

Conclusion

This case report highlights the rare, but potentially dangerous, diagnosis of Ogilvie's syndrome after Caesarean section. It is of particular interest to obstetricians, midwifery staff and general surgeons and shows the importance of accurate diagnosis, regular abdominal reassessment and early senior input to ensure appropriate and rapid treatment.