Chronic Ogilvie Syndrome Revealed During Postoperative Rehabilitation

Abstract

Ogilvie's syndrome, or acute colonic pseudo-obstruction, is a rare condition characterized by colonic dilation without mechanical obstruction. While often seen acutely in hospitalized or postoperative patients, chronic forms are also possible. We present a case of a 73-year-old male who was admitted to inpatient rehabilitation following a posterolateral fusion at C2-T1 with decompressive cervical laminectomy, facetectomy, and foraminotomies. His medical history included cervical spondylosis with radiculopathy, gastroesophageal reflux disease (GERD), chronic constipation, and prior lumbar and cervical spine surgeries. Upon admission, he reported persistent nausea, abdominal distension, constipation, and neck pain. Physical examination revealed a nontender, firm, and distended abdomen with high-pitched bowel sounds. A kidney, ureter, bladder X-ray demonstrated colonic dilation consistent with Ogilvie's syndrome. A review of past imaging from 11 years prior confirmed chronic and previously unmanaged pseudo-obstruction. Conservative management with laxatives led to gradual improvement without surgical or pharmacologic intervention. Functional recovery was achieved with rehabilitation, and his discharge plan included follow-up with a gastrointestinal physician and home health services. This case highlights the importance of recognizing potential contributors to postoperative gastrointestinal symptoms. Early imaging review, conservative bowel management, and specialist follow-up are key in these complex patients.

Keywords: acute colonic pseudo-obstruction; autonomic nervous system dysfunction; chronic intestinal pseudo obstruction (cipo); gastrointestinal motility disorders; inpatient rehabilitation; ogilvie's syndrome; physical medicine and rehabilitation.

Figure 1. Cervical spine fluoroscopy taken before rehabilitation showed extensive fusion hardware and postoperative changes. Multiple screws are visible, illustrating the complexity of the patient’s surgical history.

Figure 2. Kidney, ureter, bladder (KUB) radiograph at the rehabilitation hospital showed diffuse dilation of the large intestine without a clear transition point. The marked colonic distension is an important clue for Ogilvie's syndrome.

Figure 3. Additional kidney, ureter, bladder (KUB) radiograph in rehabilitation, taken from a different angle, also demonstrated significant colonic dilation without an obstructive transition point. The repeated finding across views reinforces the diagnosis of pseudo-obstruction rather than a focal blockage.

Figure 4. Kidney, ureter, bladder (KUB) from 11 years prior to admission showed features of Ogilvie’s syndrome, including marked bowel dilation with a nasogastric tube in place (arrow). This historical comparison highlights the chronic nature of the patient’s condition.