We present two cases of Ogilvie’s syndrome and to raise awareness of this rare but serious complication.

Methodology: Analysis of two recent cases at our institution. Subsequent 5 year retrospective audit of all joint replacement in Tauranga Hospital and analysis of patient records with a recorded gastrointestinal complication.

We report on two recent cases of Ogilvie’s Syndrome (acute colonic pseudo-obstruction) with subsequent caecal perforation after THJR. Case 1: A 49 year old woman underwent THJR for osteoarthritis. Postoperatively developed abdominal pain and distension. Underwent laparotomy for a perforated caecum 10 days following THJR. Died 24 hours later. Case 2: A 73 year old man underwent a revision THJR. Postoperatively developed a distended abdomen. Underwent laparotomy and caecostomy 10 days after THJR. Discharged 29 days after admission. Both cases had GA and spinal anaesthetics with intrathecal Morphine. Both failed to settle with conservative treatment. There was no mechanical obstruction in either case. Audit figures showed 21 other cases of non-mechanical bowel obstruction after hip or knee arthroplasty.

Ogilvie’s Syndrome is a rare “malignant” form of postoperative pseudo-obstruction characterised by massive dilatation of the large bowel which, if untreated, results in caecal perforation. It is rare following joint arthroplasty but if occurs has a high morbidity and mortality. Prompt recognition of the presenting features by orthopaedic surgeons with expedient general surgical intervention is necessary to avoid potentially fatal consequences.