Cardiovascular Surgery and Interventions Case Report Open Access Cardiovasc Surg Int 2015;2(1):6-9 http://dx.doi.org/DOI: 10.5606/e-cvsi.2015.335 www.e-cvsi.org ©2015 Turkish Society of Cardiovascular Surgery. All rights reserved. Cardiovascular Surgery and Interventions, an open access journal www.e-cvsi.org Ogilvie’s syndrome: an uncommon gastrointestinal complication following coronary artery bypass graft surgery Hamit Serdar Başbuğ, Macit Bitargil, Kanat Özışık Received: January 26, 2015 Accepted: January 26, 2015 Published online: April 17, 2015 Department of Cardiovascular Surgery, Medical Faculty of Kafkas University, Kars, Turkey Corresponding author: Hamit Serdar Başbuğ, M.D. Kafkas Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, 36000 Kars, Turkey. Tel: +90 474 - 225 11 90 e-mail: s_basbug@hotmail.com ABSTRACT Ogilvie’s syndrome or acute colonic pseudo-obstruction is characterized by an acute distention of the large bowel in the absence of any mechanical obstruction usually occurring in critical illness or following an extensive surgery. It is a rare gastrointestinal complication of open heart surgery. Massive distention of the colon may cause perforation in the cecum which causes subsequent fecal peritonitis and associated with a high mortality rate. In this article, we report a case of acute colonic pseudo-obstruction occurring following coronary artery bypass graft surgery and our treatment approach is discussed. Keywords: Coronary artery bypass graft surgery; neostigmine; Ogilvie’s syndrome. Ogilvie’s syndrome also called as colonic pseudo- obstruction is an acute colonic dilatation without any mechanical obstruction which may develop after surgery or systemic illness. [1] It is seen in less than 3.5% of patients after cardiovascular or thoracic surgery. [2,3] This syndrome is a type of megacolon syndrome and it remains as a poorly understood condition which is characterized by massive dilatation of the colon and the presence of fluid levels on abdominal X-ray. [4] It is also associated with a broad range of medical and surgical conditions including open heart surgery, trauma, other surgical interventions, malignancy, and pregnancy. [5] It is a rare, but lethal postoperative gastrointestinal complication following coronary artery bypass graft (CABG) surgery with a mortality rate as high as 50%. [4] In this report, a patient who developed an acute colonic pseudo-obstruction (ACPO) following CABG and the treatment approach was discussed. CASE REPORT A 67-year-old male patient with no significant history except hypertension for the past five years admitted to the cardiology department with unstable angina pectoris. Coronary angiography revealed multivessel coronary artery disease and he was scheduled for CABG surgery. He had a smoking history of two- packs per day for the past 50 years. Preoperative blood tests were normal. Echocardiographic evaluation revealed a reduced ventricular function with a left ventricular ejection fraction of 35% with apical dyskinesia and no significant valvular pathology. His routine anti- hypertensive prescription included an angiotensin receptor blocker monotherapy. After performing four vessel CABG surgery, the patient was transferred to the intensive care unit with an infusion of moderate doses of positive inotropic agents. The intra-aortic counter pulsation was established in the postoperative seventh hour due to the low cardiac output. Hemodynamically-stabilized patient was extubated on the postoperative first day. The inotropic agents were initiated to attenuate gradually. The otherwise stable patient developed an abdominal distention during the end of postoperative first day. Gastrointestinal symptoms worsened on the second day. All blood tests and blood gas analysis produced normal results without any electrolyte imbalance. On physical examination, diminished bowel sounds with a markedly distended abdomen were inspected. The abdominal palpation was painful. However, there was no rebound, an indicator of the peritoneal irritation. The erected position plain abdominal roentgenogram revealed a generalized significant