Ogilvie's syndrome is a syndrome of acute colonic pseudo-obstruction (ACPO). The character is massive dilation of the colon and without demonstrable intestinal obstruction. Olgivie's syndrome remains difficult to diagnose and is still associate with significant morbidity and mortality. We present a 42-year old man who was admitted because of C- spine injury with paraplegia suffered from sudden onset abdominal fullness after tracheostomy. Plain abdominal X-rays revealed massive dilation of the colon. Abdominal Computed tomography scan excluded mechanical obstruction. Symptoms improved after conservative management with nasogastric tube and anal tube decompression.