Acute colonic pseudo-obstruction (Ogilvie's syndrome) with caecal perforation after caesarean section

Acute colonic pseudo-obstruction in polytrauma patients

BACKGROUND

Acute colonic pseudo-obstruction (ACPO) is characterized by severe colonic distension without mechanical obstruction. It has an uncertain pathogenesis and poses diagnostic challenges. This study aimed to explore risk factors and clinical outcomes of ACPO in polytrauma patients and contribute information to the limited literature on this condition.

METHODS

This retrospective study, conducted at a Level 1 trauma center, analyzed data from trauma patients with ACPO admitted between July 2009 and June 2018. A control cohort of major trauma patients was used. Data review encompassed patient demographics, abdominal imaging, injury characteristics, analgesic usage, interventions, complications, and mortality. Statistical analyses, including logistic regression and correlation coefficients, were employed to identify risk factors.

RESULTS

There were 57 cases of ACPO, with an incidence of 1.7 per 1,000 patients, rising to 4.86 in major trauma. Predominantly affecting those older than 50 years (75%) and males (75%), with motor vehicle accidents (50.8%) and falls from height (36.8%) being the commonest mechanisms. Noteworthy associated injuries included retroperitoneal bleeds (RPBs) (37%), spinal fractures (37%), and pelvic fractures (37%). Analysis revealed significant associations between ACPO and shock index >0.9, Injury Severity Score >18, opioid use, RPBs, and pelvic fractures. A cecal diameter of ≥12 cm had a significant association with cecal ischemia or perforation.

CONCLUSION

This study underscores the significance of ACPO in polytrauma patients, demonstrating associations with risk factors and clinical outcomes. Clinicians should maintain a high index of suspicion, particularly in older patients with RPBs, pelvic fractures, and opioid use. Early supportive therapy, vigilant monitoring, and timely interventions are crucial for a favorable outcome. Further research and prospective trials are warranted to validate these findings and enhance understanding of ACPO in trauma patients.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Ogilvie's Syndrome with Perforation Peritonitis after Caesarean Section

Acute colonic pseudo-obstruction in the immediate post-partum period, following Caesarean section is rare, and requires a high index of suspicion for diagnosis. Sometimes, rapidly progressive dilatation of the caecum can lead to perforation peritonitis. There are only a few case reports describing this important entity. Presented herein is a young primigravida, who developed Ogilvie's syndrome and peritonitis 5 days following an uneventful elective Caesarean section. Clinical details, management strategy adopted and a brief review of literature is presented to draw attention to this condition.

Main Bronchus Stenosis Due to Tuberculosis and Ogilvie's Syndrome: A Case Report of Two Unusual Diseases in the Same Patient

Main bronchus stenosis as a sequel of pulmonary tuberculosis is infrequent and should raise suspicion of other presentations of the infection. Given its non-specific symptomatology and the absence of a specific diagnostic method, tracheobronchial tuberculosis is usually not suspected and diagnosed despite its great impact on quality of life due to the high incidence of stenosis as a consequence. Ogilvie's syndrome, an uncommon condition, requires careful management and surveillance given the risk of ischemia and colonic perforation intrinsic to the disease. We present a case of a patient with main bronchus stenosis secondary to tuberculosis infection and Ogilvie's syndrome post-surgery.

Iatrogenic caecal perforation two days after a caesarean section, a case report

INTRODUCTION

and importance: The caesarean section is a widely spread procedure and 29.7 million times performed every year inn 169 countries in the world. Overall, complications are seen in 6% for elective caesarean to 15% for emergency caesarean.

CASE PRESENTATION

We here report a case which was initially diagnosed as a postoperative paralytic ileus. After a complicated caesarean section caused by bleeding and problems with haemostasis, a healthy child was born with full mother recovery for the first 24 hours after surgery. Unfortunately, her condition deteriorated between 24 and 48 hours and she reported progressive nausea and painful bloating. Laboratory tests and CT imaging showed progressive signs of inflammation and distention of the caecum and colon. A second CT scan the next day revealed signs of perforation. An ileocecal resection was performed with a primary anastomosis. Full recovery occurred two weeks later.

CLINICAL DISCUSSION

With an estimated incidence of only 0,08%, bowel perforations due to caesarean section, are rare. Moreover, is the clinical presentation diverse and computed topography is essential during the diagnostic process. To avoid potential morbidity and mortality, the surgeon must consider performing a laparotomy in case of a deteriorating patient in non-invasive treatment fails.

CONCLUSION

Caecal perforation must be considered as complication after a caesarean section. An ileocecal resection is necessary in this situation. This case report shows that a primary anastomosis is a possible option in a healthy patient that is hemodynamically stable during the operation. In case of an unhealthy or hemodynamic unstable patient, the safest option is a temporary ileostomy.

Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report

Background

Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications.

Case presentation

A 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later.

Conclusion

Ogilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.

Pseudoobstrucción colónica aguda (Sindrome de Ogilvie) posterior a una nefrectomía radical: Reporte de caso

El Sindrome de Ogilvie se caracteriza por una dilatación masiva del colon y una clínica sugestiva de obstrucción intestinal mecánica, sin causa orgánica. Presentamos un caso de dilatación aguda idiopática del colon secundaria a una cirugía abdominal.

El objetivo de este reporte fue la descripción de una patología urológica inusual que puede pasarse por alto o tratarse como un íleo adinámico y, la revisión de la literatura relacionada con la definición, factores de riesgos, etiología, fisiopatología y el tratamiento de la misma.

Paciente masculino de 61 años con antecedente de nefrectomía radical izquierda por tumor renal que, a las 48hs del alta hospitalaria, consultó por presentar distensión abdominal aguda. Se solicitó una radiografía abdominal y una tomografía computada que evidenciaba importante dilatación intestinal y un diámetro cecal mayor a 12cm.

Se practicó una laparotomía exploradora de urgencia constatándose dilatación colónica del colon transverso y ascendente con un cambio de diámetro a nivel del ángulo esplénico, sin causa osbtructiva. Finalmente, se realizó colostomía en asa.

A los 6 meses de seguimiento, la videocolonoscopía no mostró lesiones endoluminales concluyendo en un Sindrome de Ogilvie secundario a la nefrectomía. Finalmente, se efectuó reconstrucción del tránsito con buena evolución posterior.

En nuestro caso, el Sindrome de Ogilvie fue una complicación postoperatoria y como fallaron las terapias conservadoras iniciales instauradas, este reporte provee una modalidad de tratamiento alternativo. Si se reconoce temprano y se trata adecuadamente, la pseudoobstrucción se resolverá en la mayoría de los pacientes y la tasa de mortalidad posterior será menor.

Case Report of Ogilvie's Syndrome Following Emergency Haemostatic Subtotal Abdominal Hysterectomy at University Teaching Hospital of Butare, Rwanda

Background

Acute colonic pseudo-obstruction or Ogilvie's syndrome is a rare condition that usually develops due to a dysregulated autonomic nervous system following a medical or surgical condition. With delayed diagnosis, it may lead to bowel ischemia and perforation with poor prognosis.

Case

We report a case of a 33 years old female, Gravida 1, Para1, who developed severe abdominal distension following abdominal haemostatic hysterectomy due to a severe postpartum haemorrhage and shock requiring epinephrine infusion after a spontaneous vaginal delivery. The postpartum haemorrhage was due to both atony and posterior cervical tear. Two initial administrations of neostigmine 2 mg mixed with atropine 0.5 mg were unsuccessful, but an insertion of a flexible recto-sigmoid cannula allowed a slight decompression. A subsequent third dose of neostigmine 2 mg mixed with atropine 0.5 mg was followed with a remarkable flatus evacuation and complete decompression.

Conclusion

Prompt diagnosis and management of Ogilvie's syndrome is crucial in order to avoid subsequent complications. In case of postoperative cecal and colonic distension without mechanical obstruction, Ogilvie's syndrome should be suspected as this will ensure timely and adequate management of patients at risk including obstetric patients.

Perforated ileus after L5-S1 anterior lumbar interbody fusion: a case report presentation

Acute colonic pseudo-obstruction (ACPO) as a result of anterior lumbar spinal surgery can result in colonic perforation. ACPO is often treated successfully with conservative measures, reserving surgical intervention for severe cases. The most severe cases can result in colonic perforation with a concomitant high mortality rate. Herein we outline a case of a 72-year-old male with multiple medical comorbidities and history of intermittent constipation who underwent anterior lumbar interbody fusion (ALIF) of L5-S1. The patient's multiple medical comorbidities placed him at risk for ACPO. His postoperative course was complicated by an ileus. The patient initially underwent conservative management that failed, resulting in colonic perforation. He underwent urgent exploratory laparotomy and repair of colonic perforation by the general surgery service. The patient had spontaneous return of bowel function on postoperative day 5, and at 6 months, he was doing well. The main purpose of this case report is to present a unique case of colonic perforation after ALIF. Understanding patient risk factors can help in early identification and treatment of potentially life-threatening complications. Surgeons should discuss the possibility of this complication with the patient during surgical counseling for anterior lumbar surgery.

Ogilvie's Syndrome after Cesarean Section: Case Report in Saudi Arabia and Management Approach

Background

Acute colonic pseudoobstruction or Ogilvie's syndrome is a rare entity that is characterized by acute dilatation of the colon without any mechanical obstruction. It is usually associated with medical disease or surgery and rarely occurs spontaneously. If not diagnosed early, Ogilvie's syndrome may cause bowel ischemia and perforation.

Case

A G7P4+2, 40-year-old woman, who is a known case of gestational diabetes mellitus during her current pregnancy, four previous cesarean sections, two early pregnancy losses at six-week gestation, and hypothyroidism, underwent uncomplicated elective cesarean section, after which she complained of abdominal distention.

Conclusion

Ogilvie's syndrome is a rare condition yet of interest to obstetricians, midwifery staff, and general surgeons because its early diagnosis and prompt treatment are the keystones to avoid any subsequent fatal complications. This case report reviews the clinical characteristics, diagnostic methods, and management of Ogilvie's syndrome. Moreover, we suggest a management approach to help in early diagnosis and prompt management to improve the outcome of this potentially serious condition.