Ogilvie syndrome is characterized by clinical and radiographic evidence of severe intestinal obstruction, in the absence of mechanical causes, with ischemic and perforative innards manifestations and with high mortality rate. There are numerous predisposing diseases, such as infections, cardiopathies, vertebral and retroperitoneum traumas and hip surgery, especially prosthetics. It is characterized by an autonomous alteration of intestinal motility, with pseudo–obstruction and dilatation of the colon, correlated with a parasympathetic depression (which increases intestinal motility) or an activation of the sympathetic. The prognosis is affected by precocity of the diagnosis, but also influenced by many other factors, such as: age; general debilitated state;degree of cecal dilatation; anatomical state of the intestine; and delay in decompression. The most serious complication is the perforation of the colon. An appropriate and immediate pharmacological treatment can eradicate the complication that also makes use by surgical decompression aimed at avoiding the conditions of intestinal ischemia and / or perforation. The described case of a patient operated by hip arthroplasty that we describe is peculiar to the diagnostic difficulty and rapid evolution.