Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) Associated With Herpes Zoster Infection: A Case Report

Abstract

Ogilvie's syndrome is an uncommon but potentially serious condition characterized by colonic dilatation in the absence of mechanical obstruction. Although typically associated with postoperative states, trauma, or pharmacologic agents, its occurrence secondary to herpes zoster is exceedingly rare. In this case report, we present a 78-year-old male with generalized abdominal pain, abdominal distention, obstipation, constipation, and herpetiform rash. The treatment modalities include bowel rest, intravenous fluid therapy, and correction of any existing electrolyte imbalances, followed by the initiation of parenteral nutrition, nasogastric tube, and enemas to reduce the risk of complications. Pharmacologic treatment with antiviral therapy and neostigmine is used in select cases. Surgical management is indicated when both therapies fail or complications exist. The purpose of this case report is to highlight the importance of considering herpes zoster as a rare but significant cause of acute colonic pseudo-obstruction. Early recognition and prompt initiation of antiviral therapy may lead to rapid clinical improvement and prevent complications.

Keywords: acute colonic pseudo-obstruction; herpes zoster; ogilvie syndrome; surgery; visceral neuropathy.

Figure 1. Clinical presentation of herpes zoster dermatosis

Figure 2. Plain abdominal radiography compatible with functional intestinal obstruction

Figure 3. Clinical presentation of the evolution of herpetiform rash involving T-8 to T-9 dermatomes

Figure 4. Flowchart of management for Ogilvie’s syndrome and herpes zoster virus infection