Ogilvie’s syndrome following caesarean section

Abstract

Acute colonic pseudo-obstruction syndrome, also known as Ogilvie's syndrome, is a rare condition associated with significant morbidity and mortality. We report a case that developed very rapidly after emergency caesarean section. A 20-year-old woman underwent an emergency caesarean section for failure to progress in the first stage of labour and a healthy male infant was delivered without incident. However, soon afterwards the patient developed significant abdominal distension and pain. Ogilvie's syndrome was diagnosed following an abdominal x-ray which revealed a gross large bowel obstruction without mechanical cause. To prevent caecal rupture, the patient underwent successful emergency colonic decompression.

Acute colonic pseudo‐obstruction after caesarean section: a review and recommended management algorithm

“…For pregnant women who have undergone caesarean section, multiple factors may contribute to the development of ACPO (Figure ) and, even in the absence of caesarean section, pregnant women are at risk . Theories for this include compression of the sacral parasympathetic plexi by the gravid uterus, the inhibitory effect of progesterone on intestinal motility, increased sympathetic nervous system activity in pregnancy and the inflammatory effects of prostaglandins and other cytokines in labour . Specific to caesarean section, it is possible that ischaemia, inflammation or direct damage to the sacral parasympathetic supply to the pelvis are major contributors .…”

“…4,[19][20][21][22] Theories for this include compression of the sacral parasympathetic plexi by the gravid uterus, the inhibitory effect of progesterone on intestinal motility, increased sympathetic nervous system activity in pregnancy and the inflammatory effects of prostaglandins and other cytokines in labour. [23][24][25] Specific to caesarean section, it is possible that ischaemia, inflammation or direct damage to the sacral parasympathetic supply to the pelvis are major contributors. 4 It is unclear why ACPO is more common following emergency caesarean section, but it may reflect a higher risk of damage to surrounding structures, ischaemia secondary to increased blood loss and inflammation from a heightened stress response.…”

Complications of caesarean section

“…Ogilvie syndrome is defined as acute large bowel obstruction without a mechanical cause . It is not specific to caesarean section but can occur in any patient undergoing surgery and, indeed, has been reported in nonsurgical patients with serious underlying medical conditions.…”

“…The exact pathophysiology is unknown but it may be due to an imbalance in the autonomic innervation of the distal colon leading to atony and subsequent proximal dilatation. During a caesarean section, Ogilvie syndrome may be caused by damage to the sacral parasympathetic nerve supply, which runs close to the cervix, vagina and broad ligament . The classic presentation is progressive abdominal distension, which may initially be painless and associated with varying degrees of constipation.…”

“…For caecal diameters of greater than 10–12 cm, the patient should have urgent colonic decompression with a rectal flatus tube. Most patients will recover quickly but if decompression fails or there is evidence of peritonitis, laparotomy and bowel resection is required . Some case reports suggest earlier surgical intervention at smaller caecal diameters but the key to management is prompt recognition and general surgical input …”