Fatal Ogilvie's syndrome after hip surgery and review of the literature

Abstract

Ogilvie's syndrome refers to a massive dilation of the colon without mechanical obstruction. Although this syndrome is well-known in the clinical literature and may sometimes be encountered as a complication of abdominal, pelvic, or hip surgery, it has only been reported sporadically in the forensic literature. We present the case of a forensic autopsy carried out on a patient whose death was related to cecal necrosis with acute peritonitis due to Ogilvie's syndrome following hip surgery. This diagnosis was based on clinical data, post-mortem imagery, autopsy findings, histological analysis, post-mortem chemistry, and microbiological analysis. A review of the literature and possible physiopathology of this disease are performed, while focusing on medico-legal perspectives.

Keywords: Acute colonic pseudo-obstruction; Autopsy; Ogilvie’s syndrome; Post-mortem.

Fig. 1

a Post-mortem CT-scan showing dilation of the cecum (red star). b Autopsy in situ view of the anterior part of the cecum presenting diffuse green-brownish discoloration with a red–purple well delineated edge (red arrow)

Fig. 2

Cecal wall necrosis with diffuse polymorphonuclear neutrophil (PMN) infiltration (inset) (hematoxylin and eosin, 40 ×). Inset: Close-up view of PMN infiltration highlighted in the black box (hematoxylin and eosin, 400 ×)

Fig. 3

Cecal wall necrosis with diffuse polymorphonuclear neutrophil infiltration (black star) and acute peritonitis (black arrowhead) (hematoxylin and eosin, 100 ×)