Presentation
Abdominal distension and pain 2 days after cardiac surgery.
Patient Data
Colonic distension
There is colonic dilation involving the right and transverse colon with no evidence of mechanical obstructive cause. The transition to normal caliber colon is gradual and the reminder segments are unremarkable. Small bowel has normal appearances. There is a small amount of free fluid in the abdomen, with no evidence of free abdominal gas. Kidneys have normal dimensions and enhancement, showing bilateral cortical simple cysts, the larger on the left measuring 7.1 cm. In the inferior pole of the right kidney, there is an exophytic cyst measuring 2 cm that shows peripheral enhancement and heterogeneous attenuation. No hydronephrosis. Liver, gallbladder, pancreas, spleen, and adrenal glands have normal appearances. No suspicious bone lesions were seen. Small bilateral pleural effusions.
Case Discussion
Colonic dilation with no clear mechanical cause/transition point. A colonic pseudo-obstruction (also known as Ogilvie syndrome) was considered as a possibility due to the post-operative status and associated electrolyte disturbances. Patient improved one day later only with clinical management.
Adynamic ileus, which is usually associated with small bowel dilation, is a differential, although both conditions have a similar clinical management. Toxic megacolon secondary to Clostridioides difficile colitis and ischemic colitis would present with similar dilation, but associated with bowel wall thickening and associated inflammatory changes such as fat stranding.
Right kidney complex cyst was recommended for ultrasound correlation.
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