Ogilvie’s Syndrome in a 66-Year-Old Man after Diaphragmatic Plication Surgery: A Rare Postoperative Complication

Patient: Male, 66-year-old Final Diagnosis: Acute colonic pseudo-obstruction (Ogilvie’s syndrome) Symptoms: Abdomen distension • abdominal tenderness • hemodynamic instability • leukocytosis Clinical Procedure: Colonic decompression • diaphragmatic plication • endoscopy • laparotomy Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Mechanical and functional intestinal obstruction are serious postoperative complications. Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is an acute functional obstruction of the large intestine with various causes, including electrolyte disturbances, certain drugs, trauma, hypothyroidism, and, less often, certain procedures, such as abdominal, pelvic, orthopedic, cardiac, and, rarely, thoracic surgeries. It presents with abdominal dis-tension without evidence of mechanical obstruction. This report is of a 66-year-old man with postoperative Ogilvie’s syndrome 1 day after diaphragmatic plication surgery. CASE REPORT: We present a case of a 66-year-old man with no pre-existing chronic diseases who underwent diaphragmatic plication surgery performed to treat symptomatic diaphragmatic eventration, which was associated with chronic colonic dilation. One day after the procedure, the patient experienced hemodynamic instability, abdominal tenderness and distention, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). An abdominal CT scan revealed massive colonic dilation with interposition of the splenic flexure into the diaphragm. Consequently, the patient underwent emergency exploratory laparoscopy, which was later converted to upper laparotomy, during which colonic decompression was performed without identifying any evidence of incarceration. Subsequently, colonic decompression was repeated via sigmoidoscopy, and no mechanical obstruction was found. Lastly, medical treatment was effective in improving the patient’s condition. CONCLUSIONS: In this complicated case, identifying the definite diagnosis was challenging due to the unusual presentation. This rare case might contribute to recognizing a new risk factor for postoperative colonic obstruction, which is preoperative colonic dilation. Also, this case has highlighted the importance of promptly diagnosing postoperative Ogilvie’s syndrome to prevent large-bowel perforation.