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BMJ Case Reports 2017; doi:10.1136/bcr-2017-220916
  • Rare disease
  • CASE REPORT

Ogilvie’s syndrome treated with an emergency laparotomy, right hemicolectomy and end ileostomy

  1. Martin Farmer4
  1. 1Department of Urology, Royal Stoke University Hospital, Stoke-on-Trent, UK
  2. 2Department of General Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
  3. 3Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
  4. 4The Royal Stoke University Hospital, Stoke-on-Trent, UK
  1. Correspondence to Dr Andrew James Robinson, andrew.robinson2{at}uhnm.nhs.uk
  • Accepted 15 September 2017
  • Published 9 October 2017

Summary

Acute colonic pseudo-obstruction (ACPO), or Ogilvie’s syndrome, is a rare clinical entity in which there is massive non-toxic colonic dilatation in the absence of a mechanically obstructing lesion. It is an important yet poorly recognised cause of surgical morbidity and mortality occurring typically in elderly patients with multiple comorbidities. ACPO can often be reversed conservatively with colonoscopic or nasogastric decompression. Surgical intervention is seldom necessary. We present a case of Ogilvie’s syndrome in which a healthy 76-year-old man developed life-threatening pseudo-obstruction following rib polytrauma after a mechanical fall. Pneumatosis coli was evident radiologically, prompting emergency exploratory laparotomy. Operative findings of serosal tearing and ischaemic colitis necessitated treatment with right hemicolectomy and ileostomy formation. Microbiological and histopathological analyses proved negative for inflammatory, obstructive and infectious colitides. The case emphasises the importance of early recognition and timely intervention in the management of this rare yet potentially fatal cause of megacolon.

Footnotes

  • Contributors AJR was responsible for literature review and compilation of the majority of the manuscript. J-PQ was responsible for conceiving the case study, obtaining approval for publication of the case from the patient, and contributed to editing of the manuscript. AB contributed to composing, reviewing and approving the final manuscript. MF reviewed and approved the final manuscript as the overseeing colorectal consultant surgeon responsible for the management of the patient’s case.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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