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Ogilvie’s Syndrome after Lumbar Spinal Surgery

  • Journal of Korean Society of Spine Surgery
  • Abbr : J Kor Spine Sur
  • 2019, 26(2), pp.63-67
  • Publisher : Korean Society Of Spine Surgery
  • Research Area : Medicine and Pharmacy > Orthopedic Surgery
  • Published : June 30, 2019

Su-Keon Lee 1,  Seung-Hwan Lee 1,  Byeong-Mun Park 2,  Bong-Seok Yang 1,  Ji-Hyeon Kim 1,  Hwan-Mo Lee 3

1광명성애병원 정형외과
2광명성애병원 정형외과학교실
3연세대학교 의과대학 정형외과학교실

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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. Key Words: Ogilvie’s syndrome, Ileus, Lumbar surgery

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