False Acute Large Bowel Obstruction

Overview

Acute pseudobstruction of the large intestine is also termed the „Ogilvie“ syndrome. The life- threatening condition without obvious mechanical obstruction of the intestine, results from a major enlargement of the large intestine, which, if no therapy is initiated on time, may result in perforation of the right- sided colon, most commonly of the caecum.

In this case study, the patient underwent urgent surgery for incipient caecal perforation. Nor the preoperative plain abdominal x- ray examination, abdominal CT , nor the laparotomy procedure detected any mechanical bowel obstruction. The condition was diagnosed as the Ogilvie syndrome in a chronic renal disorder of the patient. The procedure included transversostomy, drainage of the peritoneal cavity and complex management, and the patient was discharged to homecare on the ninth postoperative day. However, two weeks later, the patient was rehospitalized for bleeding from the stoma site. Colonoscopy detected a small stenosing tumor in the lienal flexure of the large intestine. The case study highlights failure of both the CT and x-ray abdominal examinations (air up to the sigmoid), as well as of the surgical exploration. Therefore, it may be concluded that not all pseudoobstructions are truely „pseudo“.

Key words:
acute pseudoobstruction of the large intestine – Ogilvie syndrome – carcinoma