Objective: To demonstrate the dynamic interplay between advanced Parkinson’s disease (PD)–related colonic dysmotility and acute colonic pseudo-obstruction (ACPO; Ogilvie syndrome) and to highlight practical red flags and escalation steps.

Background: PD is frequently complicated by progressive gastrointestinal dysmotility. In frail patients this can acutely decompensate into ACPO, a functional obstruction of the colon without a mechanical cause. Apparent “regular” bowel habits and intermittent diarrhea episodes may coexist with fecal retention, delaying recognition and treatment.

Method: Single-patient clinical case report with timeline reconstruction from hospital records. Key data included symptom evolution, abdominal CT findings, respiratory complications, and stepwise inpatient management.

Results: A 90-year-old patient with >10-year PD and severe comorbidity (post-stroke aphasia, mild right hemiparesis, dementia, PEG) received intensive home rehabilitation and nursing care with adequate enteral nutrition/hydration via PEG. Over several years, intermittent short diarrhea episodes (≤3 days) were treated symptomatically, while daily twice-regular formed stools were reported. In mid-October, new progressive lower abdominal pain and marked distension developed; abdominal CT demonstrated substantial colonic stool burden. After inpatient bowel-clearing measures and discharge for continued home bowel management, poor tolerance led to re-admission within one week. On re-admission, fever and cough accompanied worsening distension and impaired defecation; CT confirmed aspiration pneumonia and ACPO without mechanical obstruction. Escalation included bowel rest with PEG cessation and parenteral support, intensified bowel regimen, neostigmine therapy, and colonoscopic intervention. Despite escalation, clinical status deteriorated and death occurred after one month of hospitalization, attributed to ACPO complications; radiologic ischemia was not reported.

Conclusion: Advanced PD can provide a high-risk substrate for ACPO, especially in frail patients with immobility, cognitive impairment, PEG dependence, and intercurrent aspiration pneumonia. New abdominal pain/distension should trigger urgent evaluation for fecal retention and ACPO even when bowel habits appear “regular”. Early, guideline-concordant escalation is essential, yet outcomes may remain poor in severely frail PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-unholy-marriage-between-ogilvie-syndrome-and-parkinsons-disease/