Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 11 3 2026 09 28 105 110 Mehdi Hojjati Department of General Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Keihan Shabankhani Department of Anesthesiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Samira Sobhani Department of Anesthesiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2025 11 12 2026 07 22 Ogilvie Syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare condition characterized by the acute dilation of the colon without any obvious mechanical obstruction. It is most commonly seen in critically ill patients with severe underlying conditions. Its occurrence in burn patients is rare, yet significant, given the clinical challenges it presents. We present two cases of Ogilvie Syndrome in burn patients. The first patient was a 63-year-old male who sustained third-degree burns over 40% of his totalbody surface area (TBSA). On day 12 post-burn, he developed significant abdominal distension, and imaging confirmed severe cecal dilation (15 cm in diameter). The diagnosis of Ogilvie Syndrome was made, and initial treatment included nasogastric tube insertion, electrolyte correction, and discontinuation of opioids and other motility-inhibiting medications. After a partial response to intravenous neostigmine, a therapeutic colonoscopy was performed, which successfully relieved the gas buildup and led to a marked improvement in the patient’s condition within two days. The second patient, a 45-year-old female, presented with second or third-degree burns covering 30% TBSA. On day 10 post-burn, she developed mild abdominal distension and vague abdominal pain. Imaging confirmed cecal dilation of 16 cm. Treatment was initiated with nasogastric decompression, oral laxatives, intravenous neostigmine, and electrolyte correction. Within three days, her condition significantly improved, and no invasive procedures were required. Both cases highlight the effectiveness of supportive care, electrolyte management, and pharmacological treatments such as neostigmine in facilitating recovery. The main takeaway is the necessity for vigilant monitoring of burn patients, particularly those at high risk for Ogilvie Syndrome, and the importance of early, appropriate interventions to ensure better patient outcomes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1133 https://crcp.tums.ac.ir/index.php/crcp/article/download/1133/789