CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
AFRICA
335
Case Reports
A rare complication after coronary artery bypass graft
surgery: Ogilvie’s syndrome
A GULER, MA SAHIN, K ATILGAN, M KURKLUOGLU, U DEMIRKILIC
Abstract
Gastrointestinal (GI) complications occur in less than 2%
of patients undergoing open-heart surgery. Acute colonic
pseudo-obstruction, known as Ogilvie’s syndrome, is also
a rare complication encountered in 0.046% of patients
undergoing coronary artery bypass graft surgery. It is char-
acterised by massive colonic dilatation without mechanical
obstruction in patients with underlying medical or surgical
conditions. In this report we describe a patient who suffered
from acute renal failure requiring haemodialysis, and subse-
quently Ogilvie’s syndrome, which was treated with high-
dose neostigmine.
Keywords:
Ogilvie’s syndrome, neostigmine, coronary bypass
surgery
Submitted 14/4/10, accepted 16/8/10
Cardiovasc J Afr
2011;
22
: 335–337
DOI: 10.5830/CVJA-2010-064
Gastrointestinal (GI) complications occur in less than 2%
of patients undergoing open-heart surgery, with a morbidity
and mortality rate of almost 30%. They are often difficult to
diagnose, resulting in delayed treatment.
1-4
GI bleeding, mesen-
teric ischaemia, pancreatitis, cholecystitis, perforated ulcers and
ileuses are some of the complications.
5
Acute colonic pseudo-
obstruction (ACPO) is characterised by massive colonic dilata-
tion without mechanical obstruction in patients with underlying
medical or surgical conditions.
4
In this report, we describe a
patient who suffered from acute renal failure requiring haemo-
dialysis, and subsequent ACPO syndrome after coronary artery
bypass graft surgery (CABG).
Case report
The patient was a 55-year-old male with a 15-year history of non-
insulin-dependent diabetes mellitus, and hypertension for the past
three years. He had been referred the previous year to the cardiol-
ogy department for chest pain on exertion. A coronary angiogram
showed serious coronary artery disease, which suggested he
needed CABG surgery. His pre-operative medications included
oral antidiabetics, beta-blockers and angiotensin receptor block-
ers. His pre-operative blood analyses were within normal limits,
except that he was anaemic with a haemoglobin/haematocrit of
10.1 g/dl (27.3%) and serum urea/creatinine of 102/2.0 mg/dl.
After undergoing six-vessel CABG surgery, the patient devel-
oped oliguria and required continuous venovenous haemofiltra-
tion at the bedside in the intensive care unit. He also required
two additional re-explorations for bleeding, the first six hours,
and the second four days after the initial surgery. During the
re-explorative surgery, eight fresh, frozen plasmas and six eryth-
rocyte suspensions were transfused to the patient. At the end of
the 14th postoperative day, the patient was haemodynamically
stable and his general condition had improved, but he began to
complain of abdominal distention without stool or flatus passage.
On physical examination, the bowel sounds were diminished
and the abdomen was markedly distended and painful, but there
was no sign of peritoneal inflammation. Therefore, supportive
measures including nil per os with total parenteral nutrition, fluid
and potassium supplements, and placement of a rectal tube were
undertaken to decompress the dilated colonic segments.
As the patient’s renal failure failed to resolve, he began to
receive intermittent dialysis with fluid restriction, which made
it harder to regulate is caloric intake and potassium supple-
mentation. He had already been weakened by surgery. Bedside
abdominal ultrasound showed dilated and unmovable bowel
segments, with generalised fluid accumulation between them. An
abdominal antero-posterior radiography (Fig. 1) and a computer-
ised tomography (CT) scan of the patient (Fig. 2) showed dilated
colonic segments full of flatus and faeces, and caecal distension
of 11 cm, with normal-appearing small bowel segments.
Despite supportive measures, no passage of flatus or stool
was observed and the abdominal distention failed to resolve. One
week after the onset of the abdominal symptoms, we decided to
administer intravenous neostigmine, since we had not been able
to find any evidence supporting obstruction, even on CT or ultra-
sonography. Half an hour after intravenous administration of 2
mg neostigmine, ordered for three days, we observed the passage
of stool and gradual relief of the abdominal distention. Thereafter,
enemas and oral laxatives were ordered to facilitate colonic
decompression. After 10 days, the patient reported no abdomi-
nal problems, describing regular bowel movements every day.
Discussion
Acute colonic pseudo-obstruction is a rare complication, encoun-
tered in 0.046% of patients undergoing CABG surgery.
6
Its first
description is attributed to William Heneage Ogilvie, who
Department of Cardiovascular Surgery, Gülhane Military
Medical Academy,
Etlik, Ankara,Turkey
A GULER, MD
MA SAHIN, MD,
K ATILGAN, MD
M KURKLUOGLU, MD
U DEMIRKILIC
