Postpartum Ogilvie's syndrome-a case report.

Abstract

Background: This case demonstrates an atypical presentation of postpartum Ogilvie's syndrome and highlights the importance of rapid recognition, multidisciplinary care and escalation of treatment to prevent maternal morbidity secondary to bowel perforation. It also raises possible risk factors to be considered for further evaluation in future research. Case: A 40-year-old multiparous woman presented in spontaneous labour at term and underwent an emergency caesarean section for fetal distress and obstructed labour. Terbutaline was used for intrauterine resuscitation, and a postpartum haemorrhage was managed with a B-lynch suture. Postpartum she rapidly deteriorated with symptoms of a bowel obstruction within twelve hours of delivery; imaging however demonstrated bowel distention extending beyond the colon. Colonoscopically guided tube decompression was pursued following a failure to improve with expectant management. Ogilvie's syndrome was subsequently diagnosed, with an incompetent ileo-caecal valve accounting for the involvement of small and large bowel loops. Gross caecal distension with ischaemic change and inevitable perforation prompted the decision to proceed with a right hemicolectomy to reduce maternal morbidity. Discussion(s): This case describes the development of postpartum Ogilvie's syndrome and highlights the importance of early recognition, multidisciplinary management and frequent reassessment of women with bowel obstruction syndrome. It also raises terbutaline and B-lynch sutures as possible associations with this condition requiring further research.