ABSTRACT
Ogilvie's syndrome (acute colonic pseudo-obstruction) is acute massive functional dilatation of bowel without a distal mechanical obstruction. It is a rare, relatively unknown but potentially lethal entity because of its propensity for caecal perforation. Although commonly a disease of elderly with underlying co-morbidities especially following surgical interventions, caesarean section is the most common predisposing factor in obstetric age group. Diagnosis depends on the gross dilatation of caecum and ascending colon and exclusion of distal mechanical obstruction. Failure to respond to conventional measures necessities decompression of colon with colonoscopy and/or tube caecostomy in patients without perforation. Any sign of perforation mandates surgical intervention in which mortality is reported to be around 40%. Increased awareness and early diagnosis are at paramount importance to prevent bowel perforation.