BackgroundOgilvie syndrome is an uncommon, potentially fatal postoperative complication manifested by abdominal distension, cecal dilatation without mechanical obstruction, and, in some cases, bowel ischemia and perforation.CasesCase 1: An 81-year-old woman underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. She was discharged and returned home on postoperative day 3 but sought treatment on postoperative day 5 for abdominal distension. Abdominal radiographs revealed a cecum dilated to 11 cm in diameter. The dilatation resolved with conservative management. Case 2: An 87-year-old woman underwent the same procedure. On postoperative day 3 she complained of abdominal distension, and her cecum measured 14 cm in diameter. Colonoscopic decompression failed, as did Cystografin enema. She successfully underwent a right hemicolectomy with primary ileotransverse anastomosis.ConclusionThe abdominal distension of Ogilvie syndrome must be differentiated from simple adynamic ileus. Early intervention may prevent mortality.