Case Report | Case Rep J. 2018;2(1):008 | Open Access

Ogilvie′s Syndrome Resistant to Medical and Endoscopic Management: A Case of the Black Cecum

George A Salem, Marcus A Toschi and William M Tierney



Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s Syndrome, is a rare finding of colonic dilatation in the absence of internal and external mechanical obstruction. This can occur after major trauma, orthopedic surgeries, hemorrhage, sepsis, and from many other causes. Typically ACPO can be managed medically with nasogastric tube decompression, repositioning, neostigmine, and endoscopic decompression. Invasive, surgical intervention is rarely needed, but can be justified with concern for bowel necrosis. We present a case of ACPO after traumatic injuries that was resistant to conservative medical therapy. A 67-year-old male presented to the trauma ICU after a fall. The patient developed acute nausea, vomiting, and abdominal pain three days after admission. Abdominal films were concerning for acute colonic distention without evidence of obstruction. Endoscopy was revealing for diffuse necrosis with friable mucosa. The patient was resistant to medical therapy and necessitated hemicolectomy, which showed transmural, ischemic bowel changes, consistent with ACPO. This scenario demonstrates a unique presentation and course of ACPO and impressive endoscopic findings of bowel necrosis.

Keywords: Endoscopy; Obstruction; Ogilvie’s; Ischemia

Citation: Salem GA, Toschi MA, Tierney WM. Ogilvieā€™s Syndrome Resistant to Medical and Endoscopic Management: A Case of the Black Cecum. Case Rep J. 2018;2(1):008