Journal List > J Korean Soc Spine Surg > v.26(Suppl 1) > 1130361

Lee, Lee, Park, Yang, Kim, and Lee: Ogilvie's Syndrome after Lumbar Spinal Surgery

Abstract

Study Design

Case report.

Objectives

We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting.

Summary of Literature Review

Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery.

Materials and Methods

An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful.

Results

The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response.

Conclusion

Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

REFERENCES

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Fig. 1.
(A, B) Preoperative anteroposterior and lateral radiographs of an 82-year-old woman show sclerotic changes and disc space narrowing at L2-3. (C, D) Postoperative anteroposterior and lateral radiographs show L2-3 decompression.
jkss-26-63f1.tif
Fig. 2.
An abdominal radiograph on postoperative day 1 shows abdominal distension and fecal impaction with gas retention.
jkss-26-63f2.tif
Fig. 3.
(A-C) An abdominal radiograph and computed tomography scan taken on postoperative day 4. The patient remained clinically stable, but an increased amount of air was noted in the colon, most notably in the cecum, which measured 11 cm.
jkss-26-63f3.tif
Fig. 4.
(A, B) An abdominal radiograph and computed tomography scan taken on postoperative day 6, at 12 hours after neostigmine administration, demonstrating a dramatic reduction in colonic air and fecal impaction.
jkss-26-63f4.tif
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