Diabetic Ogilvie's Syndrome Mimicking Colonic Volvulus: A Case Report

Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, is a rare disorder marked by colonic dilation without any anatomical obstruction in the intestinal lumen. The dilation occurs typically in the cecum and right colon, with sometimes extension to the sigmoid colon, which can mimic a colonic volvulus, especially in geriatric patients. The involved mechanism in Ogilvie's syndrome is an intestinal obstruction due to an alteration in the propulsion of the gastrointestinal tract content. The diagnosis of Ogilvie's syndrome should be made only after exclusion of a specific mechanical or toxic colonic pathology. We report a case of a 73-year-old male patient with diabetes who was admitted for diabetic ketoacidosis with infectious and digestive symptoms. He later developed intestinal obstruction with significant sigmoid colon dilation. Surgery revealed colonic dilation from the cecum to the sigmoid without volvulus, but with ischemic changes. A diagnosis of diabetic Ogilvie's syndrome mimicking sigmoid volvulus was made. The ischemic sigmoid colon was resected, and pathology confirmed no mechanical or toxic cause. The patient recovered well postoperatively.