Patient presents with acute colonic pseudo-obstruction, consistent with Ogilvie syndrome.  Symptoms include significant abdominal distension, discomfort, and nausea.  No evidence of mechanical obstruction was found on CT scan of the abdomen and pelvis.  Review of systems reveals recent hospitalization for pneumonia treated with intravenous antibiotics and electrolyte imbalances, specifically hypokalemia.  Patient denies history of abdominal surgery or other known risk factors for bowel obstruction.  Physical examination reveals a tympanitic abdomen with mild tenderness but no rebound or guarding.  Bowel sounds are present but hypoactive.  Rectal examination reveals an empty ampulla.  Diagnosis of Ogilvie syndrome is made based on clinical presentation, imaging findings, and absence of mechanical obstruction.  Initial management includes nasogastric tube decompression, correction of electrolyte abnormalities, and cessation of any contributing medications.  Neostigmine administration will be considered if conservative measures fail.  Differential diagnosis includes mechanical bowel obstruction, toxic megacolon, and colonic ileus.  Patient will be closely monitored for signs of complications such as bowel perforation or ischemia.  Continued monitoring of abdominal distension, vital signs, and electrolyte levels is essential.  Appropriate ICD-10 code K56.6, paralytic ileus and intestinal pseudo-obstruction, will be used for billing and coding purposes.  CPT codes for diagnostic imaging and therapeutic procedures will be documented according to services rendered.