Recurrence of acute colonic pseudo-obstruction post-caesarean section: a case report

摘要

Acute colonic pseudo-obstruction (ACPO) is a rare complication of caesarean section. Its incidence is unknown. Eighty-five cases were identified in the literature (MEDLINE with search terms 'pseudo-obstruction', 'caesarean' and 'Ogilvie'). We describe a unique case of recurrence of ACPO after caesarean section and the consequences of progression of disease.A 36-year-old woman (G2 P2) presented with a 2-day history of abdominal distension and pain post-elective caesarean section. This is on a background of previous ACPO after her first caesarean section, where she was managed with endoscopic decompression. Twenty-four hours after delivery, she experienced increasing abdominal distension and pain. She was given opioid analgesia, simethicone and reassured. Forty-eight hours after delivery, she was reviewed for worsening symptoms. Abdominal X-ray revealed a dilated ascending colon. Computed tomography of the abdomen/ pelvis demonstrated a caecal diameter of 8 cm with no evidence of ischaemia or mechanical obstruction (Fig. 1). She was then found to have signs of peritonism and a white cell count of 19 x 109/L. She underwent urgent laparotomy, revealing an ischaemic-ascending colon with serosal tears. Right hemicolectomy with end-to-side anastomosis and loop ileostomy was performed, with planned reversal in 3 months. She was discharged 5 days post-laparotomy with no post-operative complications.