Acute colonic pseudo-obstruction, also known as Ogilvie syndrome, is a rare postoperative complication characterized by marked colonic dilatation in the absence of mechanical obstruction.It has been reported after severe medical illness,abdominal surgery, obstetric procedures, trauma, and major orthopedic surgery. Early recognition is essential because delayed diagnosis and treatment may lead to colonic ischemia or cecal perforation. We report the case of a 59-year-old man who developed occlusive symptoms two days after total hip arthroplasty. Abdominopelvic computed tomography suggested large-bowel obstruction proximal to apparent rectal wall thickening, leading to exploratory laparotomy. Intraoperatively, diffuse dilatation of the colon and distal ileum was found without any mechanical obstacle, supporting the diagnosis of Ogilvie syndrome. A decompressive cecostomy was performed, followed by a favorable postoperative outcome. This case highlights the diagnostic difficulty of Ogilvie syndrome after orthopedic surgery and emphasizes the importance of considering this condition in any postoperative patient presenting with abdominal distension and features of bowel obstruction.