Introduction: Acute colonic pseudo-obstruction or Ogilvie syndrome is a rare but potentially fatal disorder. In addition, it can present diagnostic dilemma especially after complicated appendicitis where postoperative ileus and mechanical obstruction are more common. It has a significant morbidity and mortality rate that can be prevented by early diagnosis and prompt management. Case Report: A nine-year-old boy was presented with clinical features of a ruptured appendix. The child was taken up for an exploratory laparotomy after an initial resuscitation, postoperatively, was eventful with a continued fever (38-39°C) and abdominal distention. So a second laparotomy was undertaken 10 days later, and the patient showed dramatic improvement before he developed progressive abdominal distention, mainly due to large bowel dilatation. Therefore, a diagnosis of acute colonic pseudo obstruction predicted and the patient managed conservatively with good response. Conclusion: The possibility of acute colonic pseudo-obstruction should be considered in deferential diagnosis of bowel obstruction post-complicated appendicitis, since early diagnosis and prompt management can improve the outcome of this potentially serious condition.