An uncommon orthogeriatric syndrome: a case of Ogilvie’s syndrome

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is an uncommon postoperative complication of major orthopedic surgery that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality. Most patients who had Ogilvie’s syndrome had risk factors that could be identified preoperatively, such as immobility, elevated comorbidity, and polypharmacy, prefiguring the frail elderly patient. In modern terms, it is considered a typical orthogeriatric syndrome. In these kinds of patients, we need to be vigilant for its development and judicious in the use of epidural anesthesia. We present an ACPO case in an elderly frail patient with a hip fracture, and we review the available literature to outline clinical characteristics and outcomes. Our patient presented numerous risk factors for developing the syndrome in the preoperative period: nonautonomy in basic and daily living activities, polypharmacotherapy, spinal trauma, and hyposodiemia. In this patient, epidural anesthesia was an additional risk factor. The purpose of this case report is to emphasize the presence of this rare syndrome (1.5% of orthogeriatric patients) in orthogeriatric departments and to identify not only pharmacological, traumatic, and electrolytic risk factors but also those that can be identified even through geriatric evaluation to avoid the use of anesthesiologic techniques and drugs that may have an impact on the prognosis of these patients.