Histologic findings in Ogilvie’s syndrome

Abstract

Abstract Introduction/Objective Ogilvie Syndrome also known as acute colonic pseudo-obstruction is a rare condition characterized by massive dilation of the colon in the absence of a mechanical obstruction. Leading risk factors include critically ill or hospitalized patients with electrolyte disturbances, in the setting of surgery or trauma. It can be managed conservatively, but if unrecognized and untreated, can lead to life-threatening complications such as ischemic colitis. The purpose of this report is to describe a case with this complication and its relevant histopathological findings. Methods/Case Report A 79-year-old male who had recently undergone radical cystoprostatectomy for urothelial carcinoma presented with significant abdominal distention and unstable vital signs. CT scan showed severe cecal dilation with pneumatosis and portal venous gas concerning for ischemia and perforation. The patient subsequently underwent total colectomy. Grossly, the segment of colon showed areas of mucosal sloughing with a hyperemic and indurated serosal surface. Microscopically, the sections showed surface erosions, acute inflammatory exudate (pseudomembranes), attenuated crypts, crypt cytoplasmic mucin loss and vascular congestion, compatible with ischemic changes. In the absence of recent major surgery and critical condition pointing towards Ogilvie's syndrome, these findings can elicit the differential diagnosis of infectious colitis, drug-mediated injury, and inflammatory bowel syndrome. Results (if a Case Study enter NA) N/A Conclusion This case highlights that Ogilvie’s syndrome can histologically manifest as ischemic colitis and emphasizes that in absence of clinical impression of this syndrome a broader differential diagnosis should be entertained.