Intestinal Pseudo-Obstruction
Overview
Intestinal pseudo-obstruction is a rare condition with symptoms like those caused by a bowel obstruction, or blockage. But when the intestines are examined, no blockage is found. Instead, the symptoms are due to nerve or muscle problems that affect the movement of food, fluid, and air through the intestines.
The intestines, or bowel, include the small intestine and the large intestine, also called the colon.
Intestinal pseudo-obstruction can occur in people of any age, but it occurs more often in children and older adults. Children can have a long-lasting form of the condition called chronic intestinal pseudo-obstruction (CIP). CIP in children is usually present at birth.
In another form of intestinal pseudo-obstruction that mostly affects older adults, the colon becomes enlarged after surgery or illness. This condition is known as acute colonic pseudo-obstruction (ACPO), also called Ogilvie syndrome or acute colonic ileus. ACPO can lead to serious complications and can be life-threatening.
Causes
Normally, nerves and muscles work together to produce wavelike contractions that push food through the intestines. In intestinal pseudo-obstruction, nerve or muscle problems prevent normal contractions. As a result, people with the condition have problems with the movement of food, fluid, and air through the intestines.
When the cause of the nerve or muscle problems leading to intestinal pseudo-obstruction is not known, the condition is called primary or idiopathic intestinal pseudo-obstruction. If the cause is known, the condition is called secondary intestinal pseudo-obstruction. Causes of secondary intestinal pseudo-obstruction include:
- abdominal or pelvic surgery
- diseases that affect muscles and nerves, such as lupus erythematosus, scleroderma, and Parkinson’s disease
- infections
- medications such as opiates and antidepressants that affect muscles and nerves
Symptoms
Intestinal pseudo-obstruction symptoms may include cramps, abdominal pain, nausea, vomiting, bloating, and constipation. Occasionally, intestinal pseudo-obstruction may cause diarrhea. Over time, the condition can cause bacterial infections, malnutrition, weight loss, and muscle problems in other parts of the body. Some people develop problems with their esophagus, stomach, or bladder.
How is intestinal pseudo-obstruction diagnosed?
To diagnose intestinal pseudo-obstruction, the doctor will take a complete medical history, do a physical exam, and take x rays. The doctor will make sure that symptoms are not due to an intestinal blockage and will look for the cause of the condition, such as an underlying illness. Other testing may be needed, such as manometry to measure the patterns of intestinal contractions.
Treatments
People with intestinal pseudo-obstruction often need nutritional support to prevent malnutrition and weight loss. Enteral nutrition provides liquid food through a feeding tube inserted through the nose into the stomach or placed directly into the stomach or small intestine. Some people need intravenous feeding, also called parenteral nutrition, which provides liquid food through a tube placed in a vein.
If intestinal pseudo-obstruction is caused by an illness or medication, the doctor will treat the underlying illness or stop the medication.
Treatment may include medications, such as antibiotics to treat bacterial infections, pain medication, and medication to treat intestinal muscle problems. People with ACPO may need procedures to remove gas from the bowel. In severe cases of intestinal pseudo-obstruction, surgery to remove part of the intestine or other intestinal surgery might be necessary.