Abstract
Introduction
Ogilvie's Syndrome or Acute Colonic Pseudo-Obstruction (ACPO) is a rare condition
characterized by massive dilatation of the colon in the absence of mechanical obstruction.
About 10% of all reported cases are related to Obstetric and Gynaecological procedures,
Caesarean section being the commonest associated factor. Acute intestinal dilatation,
if not treated, may lead to perforation and faecal peritonitis with consequent high
morbidity and mortality.
Materials and methods
An electronic literature searches were performed in PubMed, EMBASE, Google scholar
and hand searches for relevant references were included without any language restriction.
All the records reported after year 2002 were included for the full review. We analyzed
the quality of the reports and the data was further analyzed for their respective
risk factors, clinical features, management methods, morbidity and mortality.
Results
The results from our searches included a total of 125 cases of postpartum ACPO. A
total of 66 cases were reported in 37 publications after year 2002. Details of delivery
were recorded in 13(19%), clinical manifestations in 49(69%), imaging results in 43(65%)
and management described in 100% of the cases. Although 62(92%) cases were following
caesarean section, no specific antepartum or intrapartum factors were associated with
ACPO. The caesarean sections performed for indications of preeclampsia, multiple pregnancy,
antepartum haemorrhage/placenta previa were more in this group of patients who developed
ACPO compared to caesarean sections performed for same indication in general population
of England and Wales. Abdominal distension and pain were the commonest symptoms, followed
by vomiting. Fever was common in patients with perforation.
Twenty eight (43%) patients had intestinal perforation or impending perforation, and
31(47%) patients required laparotomy. Conservative management was successful in 33(50%)
patients. All patients with a caecal diameter of more than 12 cm perforated compared to 3/17 with a diameter of less than 9 cm. Most perforations were diagnosed between postoperative day 3 and day 5. Only one
case of mortality has been recorded (1.5%).
Conclusions
No specific risk factors could be identified for postpartum ACPO. A postpartum patient
with abdominal distension and pain should have appropriate imaging to rule out colonic
dilatation and/or perforation. Perforation may occur with a caecal diameter of less
than 9 cm but it is more likely if the diameter exceeded 12 cm. The mortality risk appears to be low in the postpartum group compared to other
patients with ACPO. There is a need for establishing national level databases to capture
all the relevant data in a consistent manner, to understand this rare disease process.
Keywords
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Article info
Publication history
Published online: May 02, 2017
Accepted:
April 12,
2017
Received in revised form:
April 5,
2017
Received:
March 6,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
