Endocrine Abstracts

Introduction: Ogilvie’s syndrome (acute colonic pseudo-obstruction) is a syndrome in which the clinical features resemble those of mechanical obstruction with massive colonic dilatation, in the absence of any demonstrable evidence of such an obstruction in the intestine. The exact pathophysiology of intestinal pseudo-obstruction remains to be elucidated. Current theories continue to suggest the idea of an imbalance in the autonomic nervous system. The initial therapy remains conservative with supportive measures (Nil Per Os, nasogastric decompression, correction of fluid, electrolyte and metabolic disorders, reduction or discontinuance of drugs that inhibit gastrointestinal motility, and treatment of infections), followed by neostigmine, decompressive colonoscopy and finally surgery if signs of ischemia, abdominal sepsis, or perforation are present.

Case presentation: A 51-year-old Caucasian female patient with a past medical history of hypothyroidism with poor adherence to therapy presented with symptoms of abdominal colic pain, distension and obstipation, associated with nausea, puffiness of the eyes, and adynamia. At observation the abdomen was distended, with normal bowel sounds, diffusely painful to palpation but without signs of peritoneal involvement. There was no altered mental status. Laboratory tests revealed increased creatinine and creatine kinase levels, normocytic normochromic anaemia, hypokalaemia, and normal glycaemic levels. Thyroid profile and ultrasonography were suggestive of primary hypothyroidism. Tomography images were consistent with Ogilvie’s syndrome with proximal colonic dilatation until a cut off at the sigmoid, without any structural lesion visualised. The colonoscopy performed was normal. The patient underwent hormone replacement therapy, as well as supportive measures, evolving with progressive clinical and radiological improvement after a few days.

Conclusion: This case illustrates a rare association between myxoedema crisis and Ogilvie’s syndrome and the importance of prompt recognition and treatment of reversible medical causes, after excluding mechanical large bowel obstruction.