Ogilvie's Syndrome after Cesarean Section: Case Report in Saudi Arabia and Management Approach

Ogilvie syndrome with caecal perforation following cesarean section: a rare case report from Jordan

Introduction

Ogilvie syndrome is a rare condition characterized by acute colonic dilation. In 1948, H. Ogilvie first described it in medical literature. Its incidence is estimated at 100 cases per 100 000 per year in the US. Both abdominal distention and pain are considered major symptoms.

Presentation of case

A 32-year-old woman, 36+1 weeks pregnant, experienced labour pain and was admitted to the hospital. Upon examination, she was in labour, but the foetus was in a breech position, necessitating a caesarean section. After 36 h later, she returned to the emergency department with severe, 1-day-old diffuse abdominal pain, accompanied by moderate bilious vomiting and significant abdominal distension. Abdominal CT with contrast revealed pneumoperitoneum, abdominal wall emphysema, and pneumatosis intestinalis involving the caecum and ascending colon, suggesting bowel necrosis. Emergency laparotomy revealed a caecal perforation, which was closed surgically without resection.

Clinical discussion

Ogilvie syndrome is more common in males but can occur in females for several reasons, including pregnancy, caesarean section, pelvic surgeries, and trauma. Several factors contribute to the occurrence of this syndrome, such as pelvic fractures and cardiac events. Surgery may be required if there is suspicion of bowel perforation or ischaemia.

Conclusion

OS is a rare condition in women, often seen after childbirth or pelvic surgery, with an unclear cause but believed to be related to autonomic nervous system imbalance. Patients with abdominal pain and distension, without evidence of obstruction, should be evaluated for pseudo-obstruction using abdominal pelvic CT, and treatment may involve conservative measures, medication, and colonoscopic decompression.

Postpartum Multiple Colon Perforation after Cesarean Section in COVID-19 Patients: A Case Series

Introduction

Gastrointestinal symptoms are present in 50% of polymerase chain reaction (PCR)-positive COVID-19 patients. In addition, bowel abnormalities are a common finding of COVID-19, and bowel-wall disorder is reported in 31% of computed tomography images of COVID-19 patients.

Case History

We report three postpartum cases with colon perforation after Cesarean section and positive PCR for SARS-CoV-2-RNA and during the main peak of COVID-19 pandemic, who were managed by early detection, laparotomy, and effective treatment and were discharged and followed up.

Conclusion

A colonic perforation could be considered as one of the causes of abdominal pain especially in women with a past surgical history as well as patients with infectious diseases such as COVID-19. Therefore, abdominal and pelvic ultrasound or x-ray was strongly recommended for postpartum women with abnormal abdominal distension, gastrointestinal symptoms, and pain to prevent possible fetal complications.