When Ogilvie’s Syndrome complicates Cesarean delivery

Stacie* and Spencer* never imagined life could get any better! 

The couple had met online and were unable to live down the skeptical looks this drew from those who knew them! However, they went on to prove their critics wrong and three years later, tied the knot in a small exclusive wedding. 

Their busy schedules were not exactly friendly and though they desired children, they were realistic enough to know this may take time.

They only had a week of honeymoon before Spencer was called away to work, gone for two months. It was a challenging time for Tracie but she threw herself into her work and prayed for Spencer’s safe return. 

What they both did not know was that they each had a surprise they wanted to share in person! It was a wonderful reunion.

For two years now, Spencer had been applying for jobs that would allow him to settle down with much less travel, to no avail. Only to receive an email that a job he had interviewed for and long forgotten about had actually materialised and was his for the taking, should he still want it!

On the other hand, it had been two maddening weeks of morning sickness for Stacie! Her periods were generally irregular and a two-month delay was not remarkable. However, the extreme breast tenderness she had been experiencing the past four weeks was bothersome. Then two weeks back, she walked into the kitchen and found the housekeeper frying bacon and this sent her right back upstairs to the washroom. She left the poor lady distraught, wondering why she had refused her breakfast. Stacie did not believe her eyes when she saw the two pink lines on her pregnancy test kit! 

It was a blissful pregnancy for both of them. Spencer was present at all clinic visits, spoiling Stacie with extreme attention and care.

Together, they shopped for their unborn child with so much excitement. They paid a familiarisation visit to the maternity suite five weeks prior to the due date and were impressed with what was on offer.

Together with her sisters, Spencer secretly planned the biggest surprise baby shower ever, leaving Stacie in tears. 

The D-day finally arrived. Stacie went into labour in the night, making the drive to hospital in the wee hours of the morning quite peaceful. They were checked in to the labour unit and their obstetrician was promptly notified.

The midwife assessed Stacie and told them that she was already in active labour and the cervix was five centimetres dilated already. Stacie had an average of five more hours to go before the little one arrived. 

Labour commenced smoothly and four hours later, Stacie was in the delivery suite pushing with all her might, beads of sweat forming on her forehead and coalescing into rivulets that ran down her temples and onto her neck. Spencer was holding her hand, supporting her neck and encouraging her all the way. After an hour of great effort and no progress, the obstetrician informed them that it was time to throw in the towel —  a caesarian -section was unavoidable. 

Spencer literally paced five miles in the half hour since Stacie was taken into surgery. He finally calmed down when the midwife came out of the operating theatres wheeling his newborn daughter to the newborn unit. He was overwhelmed, shedding tears of joy unrestrained. He was also reassured that his wife was doing well, surgery was almost over and that she would be wheeled out to the post-anesthesia care unit in a little while.

Stacie’s recovery went well and within 24 hours, she was up and about, on a light diet and was learning how to breastfeed their daughter. In the evening, she firmly sent Spencer home to get the much needed rest.

The next day, Stacie complained of excessive bloating and constipation. She was given rectal suppositories, which resulted in passing stool but she still remained uncomfortable. 

On the third day, the bloating was worse, she was unable to eat anything. She vomited twice, and she was in a lot of pain. Her tummy was so bloated, she looked like she was still pregnant. Her doctor reviewed her and requested a general surgeon to step in and see Stacie. The surgeon ordered for some lab tests and X-rays and also ordered that Stacie remained on nil-per-oral. She was only allowed to swallow saliva! 

The tests confirmed that Stacie had intestinal obstruction. She remained on conservative management to see if the problem would resolve without needing repeat surgery. Unfortunately two days down the line, things got worse as tests confirmed that her intestines had indeed perforated, necessitating surgery. 

Intraoperatively, the surgeons found Stacie had suffered a rare condition known as Ogilvie’s Syndrome, a spontaneous rupture of the first part of the large intestines, the caecum. This leads to spilling of intestinal faecal matter into the abdominal cavity, causing infection and sepsis.

To repair

Surgery aims to repair the ruptured part of the intestines and wash up the spillage.  

Stacie handled the surgery well, but the post-operative period was stormy. She was eventually discharged home after 18 days. Spencer was so grateful to be taking his family home. He could not believe just how quickly tables had turned from a normal pregnancy to a rough and tumble in a fight for Stacie’s life. Life indeed can be near-miss!

Dr Bosire is an obstetrician/gynaecologist