Ogilvie's syndrome‐related right colon perforation after cesarean section: A case series

Abstract

The objective of this article is to discuss and report three cases of right colon perforation secondary to postcesarean Ogilvie's syndrome (OS; colonic pseudo-obstruction) requiring right hemicolectomy. We retrospectively reviewed the case notes of three patients who underwent caesarean section and postoperatively developed OS. OS is an uncommon problem in patients undergoing caesarean section. Abdominal X-ray and water-soluble contrast enema are the main diagnostic modalities. Drip-suck therapy along with endoscopic or pharmacological decompression should be performed in early stages. In a significant percentage of patients, diagnosis is delayed resulting in bowel ischemia and perforation requiring surgical resection and adding significant mortality/morbidity. We recommend our obstetric colleagues to involve surgical team in earlier stages to avoid surgery-related mortality and morbidity. We also advocate general surgeons to be aware of OS in patients after caesarean section and recommend a stepwise systematic approach toward the diagnosis and management of OS.

Recurrence of Ogilvie’s Syndrome, a Rare Postoperative Complication in Second Caesarean Section

“…Therefore, colonoscopic or surgical decompression needs to be reserved for situations wherein conservative treatment fails. Patient age, caecal diameter and timing of decompression influence mortality rate (15% versus 36-44%), because of ischaemia and perforation [17]. Luckily our patient did not require any aggressive treatment.…”

Ogilvie’s Syndrome after Cesarean Section: Case Report in Saudi Arabia and Management Approach

“…It is a rare condition yet it can result in dangerous complications with subsequent high mortality rate beyond 50% [ 4 ]. It can occur at any age with higher frequency in the sixth decade of life [ 5 ]. Its incidence in males is higher than that in females (1.5 : 1) [ 5 ].…”

“…Clinical and radiological findings are both needed to confirm the diagnosis of the syndrome [ 10 ]. Typically, it presents within 48h and up to 12days postoperatively and can be confused with mechanical obstruction of bowel-like paralytic ileus (see Table 1 ) [ 5 , 11 , 12 ]. Clinical features include abdominal distension with mild-to-moderate abdominal discomfort, constipation, nausea, and vomiting along with low grade fever [ 8 , 13 , 14 ].…”

“…Plain abdominal X-ray is the most useful diagnostic modality that reveals gaseous distention in colon, mostly involving the caecum and ascending colon, with or without fluid levels seen in small bowel [ 10 , 11 ]. Caecal diameter of 9–12 cm warrants ischemia and subsequent perforation if not managed urgently [ 5 ]. Though X-ray is a fundamental diagnostic modality, other modalities like CT scans and water soluble contrast enema are used to confirm the diagnosis and to exclude mechanical obstruction [ 10 ].…”

“…Management for uncomplicated patients is initially conservative with limiting oral intake, active mobilization, cessation of opioids, and correction of electrolytes, and underlying comorbidities should be treated [ 14 ]. Intravenous hydration, nasogastric decompression, rectal tube decompression, close clinical monitoring with serial physical examinations, laboratory studies, and abdominal radiological modalities should be done [ 5 ].…”