Acute colonic pseudoobstruction (Ogilvie’s syndrome) in gynecologic and obstetric patients: case report and systematic review of the literature
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Acute colonic pseudo-obstruction or Ogilvie’s syndrome (OS) is a rare form of postsurgical or posttraumatic complication. OS rarely occurs in the postoperative course of gynecologic and obstetric patients and is difficult to diagnose.
We present the case of an 83-years-old patient with carcinosarcoma of the uterus who developed OS with non-obstructive dilation of the right hemicolon and intraabdominal compression after total abdominal hysterectomy, omentectomy, and lymphadenectomy. Laparotomy with colonic decompression and abdominal dressing was performed. Subsequently, the patient developed pneumonia and peritonitis and died due to septic shock.
Systematic literature review
We identified 49 case reports and 10 case series describing 17 gynecologic (cervical cancer, n = 2; carcinosarcoma of the uterus, n = 1; benign gynecologic condition, n = 14) and 76 obstetric patients (cesarean section, n = 66; OS during pregnancy or after vaginal delivery, n = 10). Outcome data were available for 59 patients. First-line treatment was conservative in 22/59 (37%) cases, laparotomy with decompression or colon resection was performed in 20/59 (34%) cases, endoscopic decompression in 12/59 (20%) cases, and i.v. neostigmine in 4/59 (7%) cases. Resolution was achieved in 22/59 (37%) of patients. The most common second-line treatment was right hemicolectomy. Adverse events grade 3 and 4 were observed in 8/59 and 31/59 patients (together 66%), respectively, mortality was 3/59 (5%).
OS is a rare postoperative complication of gynecologic and obstetric patients with a good prognosis, but a high morbidity. Pregnancy seems to be a predisposing factor for OS. Conservative treatment is a successful first-line approach.
KeywordsOgilvie’s syndrome Pseudo-obstruction Colon dilatation Bowel decompression Gynecology Surgical complication
Magnetic resonance tomography
Nil per os
Common Terminology Criteria for Adverse Events
CBT, AD and ZH collected data and wrote the manuscript. GR analyzed the data and contributed to writing the manuscript. All authors participated in discussion and revision of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 2.Conner S, Mitchell C. Ogilvie Syndrome. StatPearls Publishing, Treasure Island (FL). Available online at https://www.ncbi.nlm.nih.gov/books/NBK526102.
- 13.Munzar Z, Munir TA, Asad M (2013) Ogilvie's syndrome (acute colonic pseudo-obstruction) after caesarean section. J Coll Physicians Surg Pak 23:298–300Google Scholar
- 20.Wignakumar V, Eriksen CA, Ebbs SR (1995) Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following caesarean section under epidural anaesthesia. S Afr J Surg 33:73–75Google Scholar
- 21.Nishida S, Tanaka K, Kawaji H, Hamada N, Ono T, Taira A (1993) Ogilvie's syndrome in pregnancy–a case report. Nihon Geka Gakkai Zasshi 94:182–184Google Scholar
- 23.Weber P, Heckel S, Hummel M, Dellenbach P (1993) Syndrome d'Ogilvie après césarienne. A propos de trois cas. Revue de la littérature. J Gynecol Obstet Biol Reprod (Paris) 22:653–658.Google Scholar
- 24.Imai A, Mikamo H, Kawabata I, Kondoh H, Tamaya T (1990) Acute pseudo-obstruction of the colon (Ogilvie's syndrome) during pregnancy. J Med 21:331–336Google Scholar
- 26.Schreiner B (1988) Das Ogilvie-syndrom als Komplikation nach erweiterter abdominaler totaler Hysterektomie. Schweiz Med Wochenschr 118:726–728Google Scholar
- 31.Lang CL, Haveman MC, Achiam M (2013) Vellykket konservativt behandlet caecumperforation ved Ogilvies syndrom. Ugeskr Laeg 175:1120–1121Google Scholar
- 35.Bhatti ABH, Khan F, Ahmed A (2010) Acute colonic pseudo-obstruction (ACPO) after normal vaginal delivery. J Pak Med Assoc 60:138–139Google Scholar
- 38.Tung CS, Zighelboim I, Gardner MO (2008) Acute colonic pseudoobstruction complicating twin pregnancy: a case report. J Reprod Med 53:52–54Google Scholar
- 42.Busch FWJ, Hamdorf JM, Carroll CS, Magann EF, Morrison JC (2004) Acute colonic pseudo-obstruction following cesarean delivery. J Miss State Med Assoc 45:323–326Google Scholar
- 45.Schjoldager BT, Sørensen JL, Svaerke T, Berthelsen JG (2001) Ogilvies syndrom efter sectio. Ugeskr Laeg 163:3064–3068Google Scholar
- 46.Cantiello L, Laghi A, Ferrara I, Lauro C (1996) Sindrome di Ogilvie. Descrizione di due casi. Minerva Ginecol 48:211–214Google Scholar
- 47.Pecha RE, Danilewitz MD (1996) Acute pseudo-obstruction of the colon (Ogilvie's syndrome) resulting from combination tocolytic therapy. Am J Gastroenterol 91:1265–1266Google Scholar
- 53.Walss Rodríguez RJ, Hernández Román P, Siller Rodríguez G (1990) Pseudobstrucción del colon (síndrome de Ogilvie), asociado a operación cesárea. Informe de dos casos y revisión de la literatura. Ginecol Obstet Mex 58:289–291.Google Scholar
- 56.Moore JG, Gladstone NS, Lucas GW, Ravry MJ, Ansari AH (1986) Successful management of post-cesarean-section acute pseudoobstruction of the colon (Ogilvie's syndrome) with colonoscopic decompression. A case report. J Reprod Med 31:1001–1004Google Scholar
- 58.Choo YC (1979) Ileus of the colon with cecal dilatation and perforation. Obstet Gynecol 54:241–245Google Scholar
- 59.DePalma RT (1978) Nonobstructive cecal dilatation and perforation after cesarean section. Obstet Gynecol 52:61S–63SGoogle Scholar
- 60.Rudigoz RC, Bérard P, Hallonet P (1978) Idiopathic perforations of the caecum after caesarean section. A new case report. J Gynecol Obstet Biol Reprod (Paris). 7:1253–1256.Google Scholar
- 64.National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v4.03. 2010. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm. Accessed 22 Nov 2018.