Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is a disorder characterized by acute dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents. It is characterized by massive dilatation of the cecum and right colon on abdominal X-ray. The main clinical feature in patients with acute colonic pseudo-obstruction is abdominal distension. We present a case of an elderly male who developed late Ogilvie’s syndrome after a month of unilateral total knee arthroplasty (TKA). He was managed conservatively but later developed cecal perforation and was operated upon. However he succumbed to his illness. The diagnosis and management of the case and Ogilvie’s syndrome is discussed.