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Acute colonic pseudoobstruction (Ogilvie’s syndrome) in gynecologic and obstetric patients: case report and systematic review of the literature

  • General Gynecology
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Abstract

Background

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.

Case presentation

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%).

Conclusion

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.

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Data availability

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Abbreviations

OS:

Ogilvie’s syndrome

MRT:

Magnetic resonance tomography

CT:

Computed tomography

POD:

Postoperative day

NPO:

Nil per os

CTCAE:

Common Terminology Criteria for Adverse Events

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  1. Department of Obstetrics and Gynecology, Ruhr-Universität Bochum—Marien Hospital Herne, Hölkeskampring 45, 44625, Herne, Germany

    Clemens B. Tempfer, Askin Dogan, Ziad Hilal & Günther A. Rezniczek

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  1. Clemens B. Tempfer
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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.

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Correspondence to Clemens B. Tempfer or Günther A. Rezniczek.

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Tempfer, C.B., Dogan, A., Hilal, Z. et al. Acute colonic pseudoobstruction (Ogilvie’s syndrome) in gynecologic and obstetric patients: case report and systematic review of the literature. Arch Gynecol Obstet 300, 117–126 (2019). https://doi.org/10.1007/s00404-019-05170-4

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