Medical management of Ogilvie’s syndrome after cesarean delivery: A case report

Abstract

Background: Neostigmine is a drug commonly used, thus making it a possible second line of treatment
after conservative methods have failed and surgery is not feasible.
Case presentation: A para 3+1 gravida 4 was admitted for elective caesarean delivery because of two
previous scars at term. She had undergone five previous abdominal surgical procdures. Her antenatal
follow-up was uneventful. Perioperative vital signs were within normal limits, with normal systemic
examination findings. She had abdominal surgical scars, three of which were well healed with no hernia
orifices. Leopold’s maneuvers and perioperative laboratory parameters were within normal limits.
Intraoperatively, dense adhesions involving the omentum and small gut were attached to the anterior
abdominal and uterine walls along the incision site. The washout of the abdomen and close inspection of
the omentum confirmed no gut or bladder injury. Postoperatively, she had progressive abdominal
distension with constipation on day three. Abdominal X-ray and computed tomography revealed multiple
air-fluid levels and grossly dilated bowel loops. There was no improvement after conservative
management, and on the sixth postoperative day, the decision to use neostigmine in an intensive care
unit setting was reached. Following a single attempt, success was achieved, and the patient opened her
bowels. Subsequently, she regained normal bowel function, and after two months of follow-up, the patient
is faring well.
Discussion: Ogilvie’s syndrome is defined as colon pseudoobstruction. It is rare (1:1000 admissions
annually) but causes severe morbidity and mortality. The rate is noted to be increasing because of
increased cesarean delivery rates globally. Diagnosis is based on clinical and imaging findings.
Challenges in diagnosis due to challenges in identification and reduced clinician index of suspicion lead
to delays in treatment. Neostigmine plays a role in medical management, whereas conservative
management has not been effective.