Post Caesarean Ogilvie’s Syndrome

A 35-year-old woman underwent a caesarean at 39 weeks and 6 days of her pregnancy. The operation was done without complications. Over the next days, the patient complained about abdominal bloating and nausea. Clinical examination noted a decrease in peristalsis. The biological analysis showed an inflammatory syndrome with a C-Reactive Protein (CRP) level of 143 mg/L and hyperneutrophilia up to 13930/μl. Abdominal contrastenhanced Computed Tomography (CT) was performed and revealed distension (with air-fluid levels) of the stomach, the small bowel and both ascending and transverse colon (Figure 1). The descending and sigmoid colons showed no sign of distension. No transitional mechanical obstacle could be found. Furthermore, the presence of a pneumoperitoneum was to be seen in the light of the history of her recent caesarean section. The diameter of the caecum was 11 cm. Post caesarean Ogilvie’s syndrome was suspected and consecutively colonoscopy was carried out three days after delivery. It showed dilation of the transverse and right colonic lumen for which exsufflation was accomplished. There was an ulcerated and necrotic layer in the lower caecum towards the hepatic flexure of the colon. A close biological and clinical monitoring was recommended. The next day, the patient still complained about abdominal bloating. A plain abdominal X-ray showed an significant pneumoperitoneum and hydroaeric levels in the intestines (Figure 2). The patient underwent right hemicolectomy; anatomopathology revealed ceacal wall necrosis.