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Case 103

Ogilvie syndrome

Postoperative dyspnoea and nausea

Dr Omar Bashir

A 50 year old man underwent an above-knee amputation to remove his gangrenous leg. He developed nausea and dyspneoa on the 4th postoperative day. On examination he had tachypnoea and tachycardia, but was apyrexic. On chest auscultation air entry was reduced bilaterally at the lung bases. The abdomen, though distended, was not tender and the bowel sounds were audible. Digital rectal examination was unremarkable. A chest radiograph was requested.

Based on the findings of the chest radiograph, a plain abdominal film was requested.

A subsequent CT scan of the abdomen did not reveal a mechanical cause of the condition and colonoscopic decompression was theraputic.

Findings

The chest radiograph shows dilated loops of large bowel. This finding is confirmed on the plain abdominal film which shows a picture of large bowel obstruction. There is no evidence of free gas under the diaphragm.

Diagnosis

Acute colonic pseudo-obstruction or Ogilvie syndrome

Differential

1. Mechanical colonic obstruction
2. Toxic megacolon
3. Mesenteric ischaemia

Discussion

Acute colonic pseudo-obstruction or Ogilvie syndrome is a condition with clinical and radiological features of colonic obstruction without any evidence of a mechanical cause. Abdominal distension in this patient accounted for the respiratory distress and the dilated large bowel loops seen on the chest radiographs guided towards the correct diagnosis. Pathophysiology of Ogilvie syndrome is not clearly understood, though it is thought to be due to an imbalance in the autonomic innervation leading to a functional bowel obstruction. Ogilvie syndrome typically occurs in patients hospitalized with a significant illness e.g. severe cardio-respiratory disorders, sepsis, electrolyte imbalance and postoperatively. Left untreated it can progress to colonic perforation and peritonitis. Plain abdominal film is the initial imaging investigation of choice. Colonoscopy can be both diagnostic and therapeutic

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