Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report
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(2020) 20:727
CASE REPORT
Open Access
Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report Ying Peng* and Cheng Peng
Abstract Background: Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications. Case presentation: A 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later. Conclusion: Ogilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status. Keywords: Ogilvie syndrome, Caesarean section, HELLP syndrome
Background Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is an organic disease caused by colonic dysfunction, which may be related to the inhibition of autonomic nervous function in the colon. It is mainly characterised by an acute and extensive expansion of the colon, mainly in the cecum and the right colon. The incidence of ACPO after caesarean section * Correspondence: [email protected] Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei 230001, Anhui, P. R. China
(C-section) is extremely low, making it a rare obstetric complication [1]. A study reported the postpartum incidence of ACPO to be 1:1460 deliveries [2], and another report estimated its prevalence to be 0.4% following Csection [3]. Its symptoms are easily obscured by postoperative wound pain and uterine contractions, and the specific mechanism underlying its manifestation remains unknown. Patients experience mild symptoms, su
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