Ogilvie's Syndrome in a Patient at 23 Weeks of Pregnancy: Report of a Rare Case with Successful Surgical Intervention

Abstract

BACKGROUND Ogilvie's syndrome (acute colonic pseudo-obstruction) is a syndrome characterized by symptoms suggestive of intestinal obstruction without an identifiable mechanical cause. It presents with excessive dilation of the loops of the large intestine. The treatment options include conservative management, endoscopic methods, and surgical intervention. If appropriate treatment is not implemented promptly, this syndrome can lead to life-threatening complications for the patient. Acute colonic pseudo-obstruction typically occurs in elderly individuals with numerous chronic diseases, extensive surgeries, or trauma. In younger individuals, risk factors include gynecological procedures, pregnancy, and childbirth. CASE REPORT This work presents a case of a 30-year-old woman at 23 weeks of pregnancy. She presented with persistent abdominal pain, nausea, and vomiting for several days. The patient was initially treated at the Obstetrics Clinic, where conservative management was implemented. Due to worsening symptoms after confirming pathological distension of the colon in the magnetic resonance imaging examination, she was transferred to the surgery clinic. Due to her unstable general condition and lack of improvement with conservative treatment, she was qualified for an appendectomy with the formation of a cecostomy. The performed surgical treatment led to an improvement in the patient's condition and did not have a negative impact on the further development of the child. CONCLUSIONS Ogilvie's syndrome in pregnancy is an extremely rare condition that can lead to significant complications. Its treatment requires the coordinated efforts of a multidisciplinary team of specialists. During the course of therapy, it is important to consider the limitations imposed by pregnancy on diagnostic and therapeutic methods.

Figure 1.

In the abdominal MRI of the patient, enlarged loops of the colon (green arrow) and a single fetus in the uterine cavity (red arrow) are visible.

Figure 2.

Dilated loops of the large intestine (red stars) with visible fluid (blue arrow) and gas (orange arrow) levels.

Figure 3.

Image during surgery. Significant dilation of the large intestine above 10 cm visible. Current serosal membrane damage present (black arrow).

Figure 4.

Dilatation of the loops of the large intestine from the splenic flexure to the sigmoid colon. Multiple ruptures of the serosal membrane are present (black arrows).