J Korean Soc Spine Surg.  2019 Jun;26(2):63-67. 10.4184/jkss.2019.26.2.63.

Ogilvie's Syndrome after Lumbar Spinal Surgery

• Lee SK
• Lee SH
• Park BM
• Yang BS
• Kim JH
• Lee HM

• KMID: 2451315
• DOI: http://doi.org/10.4184/jkss.2019.26.2.63

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.

Keyword

Ogilvie's syndrome; Ileus; Lumbar surgery

MeSH Terms

Aged, 80 and over
Asthma
Back Pain
Colon
Colonic Pseudo-Obstruction*
Cushing Syndrome
Decompression
Diagnosis
Diagnosis, Differential
Early Diagnosis
Enema
Female
Humans
Hypertension
Ileus
Ischemia
Laminectomy
Laxatives
Leg
Magnetic Resonance Imaging
Mortality
Nausea
Neostigmine
Spinal Stenosis
Urinary Bladder
Vomiting
Walking
Laxatives
Neostigmine

Figure

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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.

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  Fig. 2. An abdominal radiograph on postoperative day 1 shows abdominal distension and fecal impaction with gas retention.

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  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.

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  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.

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