Safer Care Victoria has been notified by CCOPMM of an unexpectedly high number of cases of Ogilvie’s syndrome in women after caesarean section.
Advice for clinicians
Consider Ogilvie’s syndrome for any woman who presents with progressive abdominal distension 2 to 12 days after caesarean section.
Order appropriate imaging to rule out colonic dilatation and perforation.
If you suspect Ogilvie’s syndrome:
- immediately escalate to a senior obstetrician
- generate an urgent referral for general surgical review.
Signs and symptoms
- progressive abdominal distension
- postoperative bleeding haemodynamically unstable
- significant bowel distension
- signs of peritoneal irritation.
Ogilvie’s syndrome is often associated with abdominal pain, nausea and vomiting, initially mimicking paralytic ileus.
Ogilvie’s syndrome is often associated with significant narcotic use.
If not diagnosed, the bowel may perforate requiring a laparotomy, bowel resection and formation of a stoma.
The opportunity for colonic decompression or neostigmine therapy is limited.
Avoid aperients, antiflatulents, antispasmodics. Reduce opioids.
Ogilvie’s syndrome (acute colonic pseudo-obstruction) is defined as an acute dilatation of the colon usually involving the caecum and right hemicolon, without any existing mechanical obstruction.
The Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) has reviewed seven cases in the past year. It found:
- there was no specific risk factors for acute colonic obstruction, but cases were seen in association with significant narcotic analgesia
- Ogilvie’s syndrome developed in healthy women, as well as those with co-morbidities
- some untreated cases led to perforation and faecal peritonitis with consequent increased morbidity and mortality.
Maternity and Newborn Clinical Network