The authors report their experience in the management of Ogilvie's syndrome, a rare form of large bowel acute pseudo-obstruction. The study includes fifteen cases of the disease. There were ten males and five female, with a mean age of sixty-two years (range 45-92). Three patients were only treated with medical and conservative measures, one with unsuccessful colonoscopy and twelve (two with colonic perforation) underwent laparotomy. The surgical procedures performed were tube cecostomy (40%), colonic resection with primary anastomosis (27%) and exploratory laparotomy with decompression (13%). The overall morbidity and mortality rate were respectively 0 and 13%. Our epidemiological, clinical and therapeutic results are similar to those reported in the international literature. The pathophysiology of the syndrome is still unknown. It can be "idiopathic" or can complicate other diseases or surgical procedures (urological and gynaecological procedures mostly). Plain abdominal roentgenogram is the most useful diagnostic test, but colonoscopy may be an alternative diagnostic (and therapeutic) weapon. Conservative treatment is the method of choice but when the cecal diameter is more than 12 cm. (impending perforation), when the colon is perforated or when medical measures are unsuccessful, surgical procedure is compulsory. The age of the patient, cecal size, delay in colonic decompression are the most important prognostic factors. Even with a proper management, the prognosis is severe and the mortality rate is high (3-50%).