A 70 year old woman had hip surgery 2 days back for a hip fracture after a fall. There is no history of any past surgery or medication. Over the past 24 hours, she complaint of abdominal discomfo and distension. O/E- she is afebrile with: BP of 140/80 mmHg HR=110 bpm, RR=16 breaths/min She has a distended tympanic abdomen with absent bowel sounds. There is no rebound tenderness. Her erect abdominal X-ray is shown: The most likely diagnosis in this case is?

The X-ray shows a massively dilated colon extending to the rectum. These findings are consistent with colonic pseudo-obstruction or Ogilvie syndrome. The presence of gas in the colon makes small bowel obstruction unlikely COLONIC PSEUDO-OBSTRUCTION (OGILVIE'S DISEASE) Etiology: It is a form of colonic ileus which is usually caused due to Electrolyte disorders Narcotic and anticholinergic medications Immobility (as after surgery) Retroperitoneal hemorrhage or mass The patient is mostly elderly and often presents with: Abdominal distention and discomfo Abdomen is tympanic Dilated colon on plain abdominal radiography Treatment Neostigmine (acetylcholinesterase inhibitor) is used to stimulate colonic motility. It can be used once it is sure that there is no mechanical obstruction. Cardiac monitoring Atropine in case of symptomatic bradycardia Intravenous administration induces defecation and flatus within 10 minutes Surgical therapy in cases of bowel perforation or impending perforation. Oral vancomycin is the treatment for C difficile infection.