ACUTE PSEUDOOBSTRUCTION OF THE COLON AS A POSTOPERATIVE COMPLICATION OF HIP-ARTHROPLASTY

Acute pseudo-obstruction of the colon (Ogilvie syndrome) results in ma ssive colonic dilatation that mag lead to a life-threatening perforati on. This complication is known to occur after arthroplasty of the hip, yet the prevalence of the complication and its effects on the outcome of the procedure are unknown. We reviewed the records of thirty patie nts (mean age, 74.3 gears; range, fifty-six to ninety years) in whom a cute colonic pseudo-obstruction developed after hip arthroplasty betwe en 1984 and 1993. During this ten-year period, 10,468 hip arthroplasti es were performed at our institution; therefore, the prevalence of acu te colonic pseudo-obstruction was 0.29 per cent, The most common prese nting symptom was abdominal distention, which occurred a mean of 3.5 d ays (range, one to eleven days) postoperatively and was noted in twent y-seven of thirty patients. Nausea (fourteen patients), vomiting (eigh t patients), and abdominal pain (two patients) were observed less freq uently. Twenty-one associated medical complications, including pulmona ry embolism (four patients), upper gastrointestinal bleeding (three pa tients), and deep infection (not evident intraoperatively) at the site of the arthroplasty (two patients), developed in fifteen patients. Ei ghteen of the twenty-one complications occurred after the onset of col onic pseudo-obstruction. The associated medical problems resulted in f our deaths (13 per cent). Recognition by the orthopaedic surgeon of th e presenting features of acute colonic pseudo-obstruction is important in order to facilitate prompt initiation of treatment, which may hast en recovery and reduce the morbidity and the mortality associated with this complication.