Ogilvie’s syndrome is a disorder characterized by massive dilation of the colon in the absence of mechanical obstruction. Fecal impaction is typically a disorder of the elderly and results largely from the inability to sense and respond to the presence of stool in the rectum. Both conditions can present with abdominal distension and pain and both can result in colon damage if not decompressed.
A 67 year old male with a past medical history of cerebrovascular accident with left-sided residual weakness presented with abdominal distension, pain and concurrent urosepsis. Abdominal imaging revealed massive colonic dilation superimposed on a fecal impaction. Multiple attempts at mechanical disimpaction and the use of neostigmine returned the stool pattern to normal.
Multiple comorbidities in elderly patients may result in both a delay in recognition and an overlap of disease processes.