Ogilvie’s Syndrome Post-Cesarean: Recognizing a Silent Surgical Threat

Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is a rare but potentially life-threatening postoperative complication, particularly in the post-cesarean setting, where it can mimic benign ileus. The hallmark is rapid and marked colonic dilatation without mechanical obstruction, often progressing to ischemia, necrosis, or even perforation if unrecognized. This case highlights a 28-year-old postpartum patient who developed sudden abdominal distension, bilious vomiting, and sepsis by postoperative day 3. Despite initial conservative management for suspected ileus, deterioration prompted exploratory laparotomy, which revealed necrotic cecum and serosal tears, necessitating ileocolectomy. Histopathology confirmed transmural necrosis, emphasizing the mismatch between clinical-radiologic findings and surgical reality. Recovery was prolonged, with persistent inflammatory markers and later adhesiolysis procedures. This case underscores the clinical urgency of distinguishing Ogilvie’s syndrome from simple ileus, especially in the absence of classic obstruction signs. When faced with unresolving pseudo-obstruction symptoms postoperatively, early multidisciplinary intervention, combining clinical vigilance, imaging, and timely surgical exploration, is critical to reduce morbidity and prevent fatal outcomes.

Source: Kedage, V., Kallya, R. S., Patil, R. S., &Ubarale, M. (2025). Ogilvie\’s Syndrome following lower segment cesarean section: A case report. Journal of South Asian Federation of Obstetrics and Gynaecology, 17(1), 109–112. https://doi.org/10.5005/jp-journals-10006-2577