Ogilvie described this syndrome in 1948. In essence there is the appearance of obstruction of the colon without there being any obstruction present.
The condition may be due to any acute illness or post operative state. It may be more common following head injury and cardio-pulmonary bypass. It may be due to loss of sympathetic activity to the colon. For instance trouble in the retro-peritoneum (ruptured aneurysm, pancreatitis).
The trouble with acute colonic pseudo-obstruction is that it may mimic mechanical obstruction and cause diagnostic confusion. Rarely the colon may perforate in colonic pseudo-obstruction even in the absence of a mechanical obstruction.
The presence or absence of a mechanical obstruction can be clarified by a contrast enema.
Even if there is no mechanical obstruction, pseudo-obstruction may result in colonic perforation. It may be necessary to try some intra venous Neostigamine, failing that a rectal flatus tube may be passed. If that does not work then colonoscopic decompression may be attempted (perforation rate 3%). If this does not work then laparotomy with resection may be required.