A Challenging Case of Recurrent Ogilvie Syndrome: Exploring Causes and Treatment Modalities

Introduction: Acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is a rare condition marked by significant colon distention without mechanical obstruction. Symptoms include abdominal pain, bloating, nausea, vomiting, and an inability to pass gas or stool. Although common in males over 60, we report a challenging case of a 44-year-old man from Africa with recurrent abdominal distention and discomfort. Ultimately, he improved after receiving multiple treatment modalities, highlighting the complexities of Ogilvie syndrome management. Case Presentation: A 44-year-old Nigerian male in the United States with hypertension and significant alcohol use disorder presented with altered mental status and bilateral lower extremity weakness after fasting and hydrochlorothiazide abuse. Initial diagnostics indicated metabolic encephalopathy from hypokalemia and dehydration. Despite aggressive treatment, he developed severe abdominal distension and obstipation. A CT scan showed diffuse colonic dilatation without a normal small bowel. Conservative measures failed, necessitating ICU transfer, TPN, and empiric antibiotics. Despite an initial response to colonoscopy decompression, the patient experienced recurrence. Neostigmine significantly improved his condition, leading to full recovery and discharge. Conclusion: This challenging case highlights the complexities of managing Ogilvie syndrome and the importance of early identification and a stepwise approach to treatment. Incorporating a patient-centered plan utilizing conservative measures, pharmacological agents and endoscopic interventions are essential for improving outcomes in these cases.