Massive acute colonic pseudo-obstruction successfully managed with conservative therapy in a patient with cerebral palsy

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a massive dilation of the colon in the absence of mechanical obstruction. Treatment measures may include anticholinergic agents such as neostigmine, colonoscopy, or fluoroscopic decompression, surgical decompression, and partial or complete colectomy. We reviewed the case of a 26-year-old male with cerebral palsy who had a history of chronic intermittent constipation who presented to the emergency department (ED) with signs of impaction despite recurrent fleet enemas and oral polyethylene glycol 3350. The patient was found to have a massive colonic distention of 26 cm likely because of bowel dysmotility, consistent with ACPO. This article includes a discussion of the literature and images that represent clinical examination, x-ray, and computed tomography (CT) findings of this patient, who successfully underwent conservative management only. Emergency department detection of this condition is important, and early intervention may prevent surgical intervention and associated complications.