Acute colonic pseudo-obstruction (ACPO), or Ogilvie’s syndrome, is characterized by dilation of part or all of the colon and rectum in the absence of any intrinsic or extrinsic mechanical obstruction. It predominantly affects people around the age of 60, with a male predominance. Its pathophysiology remains poorly understood. It often occurs in debilitated individuals. Although rare, it is serious, with a mortality rate of about 15% when treated early and appropriately, but increasing to 36–44% in cases of perforation or intestinal ischemia. Treatment may be medical, endoscopic, or surgical. Surgery is indicated when medical management fails or if there is suspicion of colonic perforation. Surgical options include cecostomy or possibly peroperative transanal pan-colorectal intubation using a multi-perforated tube via laparotomy. We report the case of an 18-year-old patient admitted for surgical management of acute intestinal obstruction due to Ogilvie’s syndrome lasting more than 24 hours, treated with a decompressive colostomy.