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.
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%).
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.
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- Casuistry in ovarian pregnancy.1978: 73-75
- Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases.Dis Colon Rectum. 1986; 29: 203-210
- The Confidential Enquiry into Maternal and Child Health (CEMACH). Why mothers die, 2000–2002. The sixth report on confidential enquires into maternal deaths in United Kingdom.RCOG Press, London2004
- Acute colonic pseudo-obstruction in pregnancy.ANZ J Surg. 2015; 85: 728-733
- Colonic pseudo-obstruction.Singap Med J. 2009; 50: 237-244
- Acute colonic pseudo-obstruction.Best Pract Res Clin Gastroenterol. 2007; 21: 671-687
- Colonic pseudo-obstruction following obstetrical surgery. A review.Diagn Gynecol Obstet. 1982; 4: 275-280
- The national sentinel caesarean section audit.BJOG. 2000; 107: 579-580
- Survey radiography of abdomen following caesarean section, with particular reference to caecal diameter and the presence of free subdiaphragmatic gas.Acta Obstet Gynecol Scand. 1976; 55: 311-314
- Colonoscopy and acute colonic pseudo-obstruction.Gastrointest Endosc Clin N Am. 1997; 7: 499-508
- Non-obstructive cecal dilatation and perforation after cesarean section.Acta Obstet Gynecol Scand. 1990; 69: 437-439
- Advances and challenges in the management of acute colonic pseudo-obstruction (Ogilvie syndrome).Clin Colon Rectal Surg. 2012; 25: 37-45
- Acute colonic pseudo-obstruction.Gastrointest Endosc. 2002; 56: 789-792
Published online: May 02, 2017
Accepted: April 12, 2017
Received in revised form: April 5, 2017
Received: March 6, 2017
© 2017 Elsevier B.V. All rights reserved.