Ogilvie Syndrome in the Setting of Myxedema Ileus: A Case Report

Ogilvie syndrome is described as the dilation of the colon without a clear mechanical obstruction. One predisposing factor to Ogilvie syndrome is hypothyroidism. The hypothyroid state can cause decreased gastrointestinal motility; however, hypothyroidism resulting in Ogilvie syndrome is a rare complication and is referred to as myxedema ileus. A review of literature shows limited reports of this specific process and none in the emergency medicine literature.

A 54-year-old woman with a history of hypothyroidism presented to the emergency department with three days of fatigue, generalized weakness, chills, diarrhea, and shortness of breath without chest pain or cough. Lab work showed high levels of ultra thyroid-stimulating hormone and decreased thyroid hormone levels. A computed tomography angiography of the chest, abdomen and pelvis showed multiple dilated loops of large bowel. Ultimately, she was diagnosed with pseudo-obstruction (Ogilvie syndrome) secondary to myxedema ileus.

Ogilvie syndrome in the setting of myxedema ileus is a serious complication that may occur in patients who are in a severe hypothyroid state. It is important for emergency physicians to consider hypothyroidism as a potential cause of intestinal pseudo-obstruction.