Myocardial injury following immediate postnatal circumcision

Abstract

was first reported by Ogilvie, ’ in 1948, at which time he described a syndrome of colic of the large intestine, due to sympathetic deprivation. Spira and associate? have reported that pregnancy accounts for 35% of all reported cases of Ogilvie’s syndrome. A review of the world’s literature has revealed 24 cases of Ogilvie’s syndrome in postcesarean section patients, including the currently reported case. The clinical characteristics associated with this syndrome are abdominal distention, pain, nausea, vomiting, radiographic evidence of dilated large bowel, with absence of air in the distal descending colon and rectum, and lack of a demonstrable lesion at laparotomy.’ The successful resolution of Ogilvie’s syndrome in the post-cesarean section patient requires early and prompt diagnosis, followed by the institution of the appropriate medical or surgical therapy. Initially, medical management includes prohibition of oral intake, gastric decompression, parenteral hydration, and electrolyte balance. Narcotic analgesics and smooth muscle stimulants are avoided. Medical management is dictated by both clinical and serial abdominal radiographic evaluations. Surgical intervention is indicated with (1) the presentation of cecal dilatation between 9 and 12 cm, (2) a large bowel obstruction unresponsive to medical management, or (3) the occurrence of a cecal perforation. The surgical goal is decompression of the right colon. Tube cecostomy has been reported to be effective, safe, and sufficient in achieving this decompression.’ The pathogenesis of Ogilvie’s syndrome, although thought to be an autonomic dysfunction, is unclear, since it does occur in a wide variety of clinical circumstances.‘. ? This patient demonstrated all the cardinal features of Ogilvie’s syndrome, including the characteristic radiographic findings of dilated large bowel in a segmental distribution pattern: a distal cutoff of colonic gas in the descending colon: the absence of air in the rectum, and the presence of air-fluid levels. Tube cecostomy resulted in the successful resolution of the problem, without further sequelae. The clinical presentation of colonic pseudo-obstruction is similar to that of adynamic ileus of the small bowel, and the differentiation of the two may some. times be difficult to make. The radiographic finding’ are quite specific and characteristic, and are an ex cellent adjunct in the diagnosis of Ogilvie’s syndrome A reduced rate of morbidity and mortality may be achieved with early and accurate diagnosis, and the institution of appropriate medical or surgical man