Management Patterns and Outcomes of Ogilvie Syndrome in the Absence of Standardized Protocols: A Single-Center Case Series From Puerto Rico

Purpose: Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), is an uncommon, potentially lifethreatening condition characterized by acute colonic dilation without mechanical obstruction.In Puerto Rico, limited access to standardized treatment pathways and gastroenterology services may complicate management in resource-limited settings.This study aimed to describe the clinical characteristics, management patterns, and inpatient outcomes of bedridden patients with ACPO treated at a secondary hospital in Puerto Rico.Case description: This retrospective observational case series included six consecutive adult patients who met the diagnostic criteria for ACPO between 2020 and 2024.All patients were bedridden and had multiple comorbidities accompanied by electrolyte abnormalities.Symptoms were present for a mean of 7.2 days before intervention.Standard conservative management consists of correction of electrolyte abnormalities, nasogastric and rectal tube decompression, neostigmine therapy, and colonoscopic decompression.Surgical intervention was performed in patients who failed conservative management or were considered at imminent risk of perforation.At this institution, where no standardized ACPO protocol was in place, surgical intervention was performed in 66.7% (n = 4), and postoperative complications occurred in 16.7% (n = 1).Colonoscopic decompression was not performed in 66.7% (n = 4), and neostigmine was not administered in 83.3% (n = 5).One patient who received comprehensive conservative management recovered without surgery.Conclusion: This case series documents inconsistent use of guideline-recommended conservative therapies alongside a high frequency of surgical intervention.Because of the retrospective design, small sample size, and absence of a comparison group, the study cannot establish that protocol availability or treatment patterns caused the observed surgical or mortality outcomes.The findings support consideration of standardized ACPO management pathways and further prospective evaluation in resource-limited settings.