Ogilvie’s syndrome can occur when the colon dilates in the absence of any mechanical obstruction in severely ill patients. This is characterized by massive dilation of the cecum (diameter > 10 cm) and right colon on an abdominal X-ray. Gaseous distension on the intestine is also present and seen with an ultrasound. This is a rare and serious complication of VZV reactivation as if the colon is not decompressed, the patient risks perforation of the colon, peritonitis, and death. The mortality rate can be as high as 40% when perforation occurs.
It is thus an imperative to diagnose and Ogilvie’s syndrome as soon as possible as the severity of the disorder is related to how what is the underlying cause of the syndrome, and diagnosis of Ogilvie’s syndrome complicated by herpes zoster is difficult as there are many clinical manifestations.
The Case Diagnosis:
The 35 year old patient had constipation 6 days ago and was not able to pass both feces and flatus 3 days ago. These were symptoms of abdominal distention and abdominal pain, which was colicky (severe abdominal pain)and moderately painful. The patient also had a single band of cutaneous vesicular eruptions on the right side of his abdomen from the T8 to T 11 dermatome for 6 days that itched and burned. A Digital rectal examination (DRE) was conducted and showed an empty, ballooned rectum.
Picture of vesicular eruption from T8 -T11 dermatomes. This picture was taken from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668305/figure/fig2/
The researchers diagnosed the 35 year old man was with paralytic ileus that associated with herpes zoster infection. The patient was managed by making him nil by mouth and by passing a nasogastric (NG) tube. IV resuscitation was started and he was kept on IV acyclovir (10 mg/kg 8-hourly). The patient’s abdominal distention gradually resolved over the next 48–72 hours and he was able to pass flatus. He was then discharged and put on oral acyclovir (800 mg five times daily for 10 days) and gabapentin (300 mg PO once daily). He had a follow-up after two weeks in the outpatient department, where he was confirmed to have a complete recovery.