BACKGROUND: Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is a rare but potentially fatal complication that may occur following cesarean delivery. As Ogilvie syndrome can demonstrate a presentation similar to ileus, small bowel obstruction, mechanical large bowel obstruction, and perforated viscus, it is important to note the distinguishing characteristics of acute colonic pseudo-obstruction in order to make a timely and accurate diagnosis with appropriate intervention. CASE: We present the case of a 33-year-old woman who developed fever, tachycardia, and physical examination findings of peritonitis on postoperative day 2 from a cesarean section. There was concern for perforation and she subsequently underwent exploratory laparotomy, upon which she was found to have Ogilvie syndrome. CONCLUSION: Postpartum women are at risk for developing Ogilvie syndrome. The diagnosis can be complicated by recent delivery, either by spontaneous vaginal delivery or cesarean section. Bowel obstruction and perforation of viscus may have a similar presentation. As management differs, it is imperative to keep Ogilvie syndrome in mind when dealing with postpartum patients with signs of peritonitis.