POST CAESAREAN SECTION OGILVIE’ S SYNDROME – AWARENESS AND UNDERSTANDING THE NEED FOR INDIVIDUALISED MANAGEMENT

Debika Bandyopadhyay MRCOG (Consultant Obstetrician and Gynaecologist), Elaine McFarlane MRCOG (ST7 Obstetrician and Gynaecologist)

Ogilvie’s syndrome, or Acute Colonic Pseudo-Obstruction, is a recognised bowel related complication of pregnancy which most commonly occurs following Caesarean Section. The risk of requiring medical or surgical intervention rather than conservative measures alone is higher in this circumstance compared to other populations1. The pyschological effects of requiring treatment with other specialties and being away from the baby are significant. We have used 3 recent cases at our institution to draw together themes of the presentation and call for individualised management. 

It is essential to personalise management to the clinical situation including recognition that obstetric patients are more likely to need active management of Ogilvie’s Syndrome. Despite early interventions one in three of our patients required stoma formation with later surgery for reversal. The impact of this condition on the early postnatal period both physically and psychologically is huge. All 3 patients had to go to theatre a second time and 2 out of 3 needed care on HDU/ITU both of which meant being away from their babies. 

Of note, all three patients had Caesareans complicated by all three patients had bowel sounds present. Often this is used as a rule out tool for post-operative ileus but should be interpreted with caution.