Ogilvie's syndrome: a rare complication of inguinal hernia repair.

Abstract

A 49-year-old man had an open, tension-free, mesh (Lichtenstein) repair performed under general anaesthetic for a left-sided direct inguinal hernia. His immediate postoperative recovery was uneventful and he was discharged the following day. He was readmitted as an emergency 2 days later with intermittent abdominal pain, nausea and complete constipation. On examination his abdomen was slightly distended, but was not tender. X-ray (Figure 1) showed dilated loops of small bowel with gas in the colon and rectum. He was managed conservatively. However, over the next 24 hours his symptoms became worse with increasing abdominal pain and vomiting. He was still passing no flatus. His abdomen became more distended and generally tender to light palpation. Repeat X-ray (Figure 2) revealed markedly distended small bowel and a grossly distended caecum. He proceeded to theatre as the caecal distension was increasing and he had developed signs of peritoneal irritation. At laparotomy his bowel was free from the left hernia repair and no mechanical cause for the obstruction was found. The colon was distended to the rectum and the caecum was 10 cm in diameter with tearing almost imminent. It was therefore decompressed with an aspiration needle and on-table sigmoidoscopy. Appendicectomy was performed and the stump used to place a caecostomy. Recovery was slow but he was discharged home 2 weeks after readmission.