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Misdiagnosed Ogilvie Syndrome

Ogilvie Syndrome is the acute obstruction of the colon, usually associated with complications following surgery. If the condition is left untreated then it can lead to perforation of the colon, with a high mortality rate.  There have been a number of reported cases in medical Journals [1] reporting on this condition following caesarean section which have been successfully treated with conservative management, but the effects of a misdiagnosis can be very serious. 

As a medical negligence solicitor specialising in obstetric cases I have dealt with cases of misdiagnosed Ogilvie Syndrome following caesarean section where the mother has suffered serious and long-term injury which should have been avoided.

WHAT IS OGILVIE SYNDROME:

Ogilvie or Ogilvie’s Syndrome is the description of a massive colonic distension where there is no mechanical cause for the colon to become obstructed.  The exact cause of the syndrome is unclear but is thought to be linked to the nervous system controlling the gut failing to function, causing gut mobility to cease and a pseudo-obstruction to occur.

The main concern of this condition is that if left untreated the bowel will perforate; perforation is associated with a mortality rate of 50% to 71% [2]; therefore the need to diagnose the condition as soon as possible is vital so try to avoid this complication.  Diagnosis of the condition is usually made by an X-ray of the abdomen.

CASE EXAMPLE:

A medical negligence claim relating to misdiagnosis of Ogilvie Syndrome is rarely defendable. It often occurs when clinicians confuse abdominal distension with a more straight forward postoperative ileus [3]. In a claim I pursued the obstetrician who reviewed the Claimant’s radiology following her caesarean section failed to notice the intestinal obstruction and discharged the mother, notwithstanding her symptoms of continued illness. The mother was advised that her abdominal pain was simply “trapped wind” and was advised to drink peppermint tea. It was only when a second midwife referred her to hospital that the diagnosis of a perforated colon was made.

The mother was very lucky to survive and required a hemicolectomy and a temporary stoma; she suffered extensive scarring as a result of the surgery and a prolonged period of care and support and was unable to care for her newborn baby.  She was also told there was a high chance she would be unable to conceive naturally in future and therefore would require IVF.

SUMMARY:

It is therefore vital that this condition is considered when a patient has appropriate symptoms and diagnosed promptly to enable treatment and to avoid long term serious complications.  It is very frustrating for patients who have suffered a failure to diagnose their condition to come to terms with the consequences of the delay in receiving treatment. This is particularly so with Ogilvie Syndrome as prompt diagnosis followed by straightforward treatment has a very high success rate and allows for a rapid recovery.

Research [3] has concluded that: “Surgeons…should include Ogilvie syndrome in the differential diagnosis when a postoperative patient’s abdomen becomes markedly distended. If appropriately diagnosed, the syndrome can be treated conservatively.”

[1] BMJ Case Rep. 2013 Jun 19;2013;  J Coll Physicians Surg Pak. 2013 Apr;23(4)
[2] Acute Intestinal Pseudo-Obstruction (Obilvie’s Syndrome) Clin Colon Rectal Surg. 2005 May; 18 (2):96-101.
[3] Ogilvie Syndrome is a postoperative complication Arch Surg. 2000;135(6):682-687

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