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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.

Alternative Names

Primary intestinal pseudo-obstruction; Acute colonic ileus; Colonic pseudo-obstruction; Idiopathic intestinal pseudo-obstruction; Ogilvie's syndrome; Chronic intestinal pseudo-obstruction

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.

Support Groups

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.

Prevention

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.