Background: In countries like Saudi Arabia where multiple nationalities are present in the same place, the rare and uncommon diseases are to be considered. Acute colonic pseudo- obstruction (ACPO), also known as Ogilvie's syndrome is an uncommon condition that occasionally develops in hospitalized patients with serious underlying illness. It is characterized by the signs, symptoms and radiological evidence of a large-bowel obstruction, but without mechanical cause. Early recognition and diagnosis of this condition allows for treatment prior to bowel perforation and requisite abdominal surgery. The aim of this study was to review our experience in assessing the circumstances, the clinical, and methods of management of acute colonic pseudo-obstruction. Patients and methods: From July 2005 to November 2015, all patients with proven acute colonic pseudo-obstruction were identified in the retrospective way at two private hospitals in Jeddah, KSA. 16 patients affected by pseudo-obstruction of the colon were reviewed. Acute dilatation of the colon without organic obstruction was the inclusion criterion for the study. Result: In the ten-year period, 16 patients had symptoms, signs and radiological appearance ACPO. Their average age was 49 years. 5 patients were post Caesarean section, 4 patients had orthopaedic procedures, one patient was post hysterectomy and 6 patients with different medical diseases. 14 patients were treated by conservative, pharmacological or colonoscopic decompression while two patients required laparotomy for perforated cecum duo to delayed diagnosis. Conclusions: Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a rare condition. It should be included in the differential diagnosis of postoperative abdominal distension and pain. Decisions about the need for pharmacological therapy, colonoscopy, or surgery should be individualized and based on the patient's clinical status. Early diagnosis can prevent major morbidity and mortality due to bowel ischemia and perforation.