Intestinal pseudo-obstruction

Also known as: Primary intestinal pseudo-obstruction, Acute colonic ileus, Colonic pseudo-obstruction, Idiopathic intestinal pseudo-obstruction, Ogilvie's syndrome or Chronic intestinal pseudo-obstruction

Definition

Intestinal pseudo-obstruction is a condition in which there are symptoms of intestinal blockage without any physical signs of a blockage.

Causes, incidence, and risk factors

In primary intestinal pseudo-obstruction, the small or large intestines lose their ability to contract and push food, stool, and air through the gastrointestinal tract.

The condition can occur suddenly (acute) or over time (chronic). It may occur at any age, but is most common in children and the elderly. Because the cause is unknown, it is also called idiopathic intestinal pseudo-obstruction (idiopathic means occurring without reason).

Risk factors include:

• Having cerebral palsy or other nervous system (neurologic) disorders
• Staying in bed for long periods of time (bedridden)
• Taking narcotic (pain) medications

Symptoms

• Abdominal pain
• Constipation
• Nausea and vomiting
• Swollen abdomen (abdominal distention)
• Weight loss

Signs and tests

Signs include:

• Nutritional deficiency

Tests include:

• Abdominal manometry
• Abdominal x-ray
• Barium swallow, barium small bowel follow-through, or barium enema
• Colonoscopy
• Esophageal manometry
• Gastric emptying radionuclide scan
• Intestinal radionuclide scan

Treatment

• Colonoscopy may be used to remove air from the large intestine.
• Fluids given through a vein (intravenous fluids) will replace fluids lost from vomiting or diarrhea.
• Neostigmine may be used to treat intestinal pseudo-obstruction that is only in the large bowel (Ogilvie's syndrome)
• Nasogastric suction -- a nasogastric (NG) tube is placed through the nose into the stomach to remove air from (decompress) the bowel.
• Special diets usually do not work, although vitamin B12 and other vitamin supplements should be used for patients with vitamin deficiency.

In severe cases, surgery may be needed.

Expectations (prognosis)

Most cases of acute pseudo-obstruction get better in a few days with treatment. In chronic forms of the disease, symptoms can return and worsen for many years.

Complications

• Diarrhea
• Vitamin deficiencies
• Weight loss

Calling your health care provider

Call your health care provider if you have persistent abdominal pain or other symptoms of this disorder.

References

Batke M, Cappell MS. Adynamic ileus and acute colonic pseudo-obstruction. Med Clin North Am. 2008;92:649-670.

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 138.

See also:

• Surgery

  Mastectomy

  

  A mastectomy is surgery to remove the entire breast. It is usually done to treat .

• Disease

  Intestinal obstruction

  

  Intestinal obstruction is a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.

• Disease

  Peutz-Jeghers syndrome

  

  Peutz-Jeghers syndrome (PJS) is a disorder often passed down through families (inherited) in which the person develops and is at a significantly higher risk for developing certain cancers.

• Disease

  Breast cancer

  

  Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer: Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type. Lobular carcinoma starts in the parts of the breast, called ...

• Symptoms

  Diarrhea

  

  Diarrhea is loose, watery, and frequent stool. Diarrhea is considered chronic (long-term) when you have had loose or frequent stools for more than 4 weeks.

• Surgery

  Breast reconstruction - implants

  After a mastectomy, some women choose to have cosmetic surgery to recreate their breast. This surgery can be performed during itself or later. The breast is usually reshaped in two stages. First a tissue expander is used. Then a saline implant is placed. Sometimes the implant can be inserted in ...

• Surgery

  Breast reconstruction - natural tissue

  After a mastectomy, some women choose to have cosmetic surgery to remake their breast. This type of surgery is called breast reconstruction. During breast reconstruction therapy using natural tissue, the breast is reshaped using muscle, skin, and fat from another part of your body. This surgery ...

Review date:

July 7, 2010

Reviewed by:

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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