Intestinal pseudo-obstruction

Causes

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 a known reason).

Risk factors include:

• Cerebral palsy or other nervous system (neurologic) disorders
• Chronic kidney, lung, or heart disease
• Staying in bed for long periods of time (bedridden)
• Taking narcotic (pain) medications or medications that slow intestinal movements (often called anticholinergic drugs)

Symptoms

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

Exams and Tests

During a physical exam, the health care provider will usually see abdominal bloating.

Tests include:

• Abdominal x-ray
• Anal manometry
• Barium swallow, barium small bowel follow-through, or barium enema
• Blood tests for nutritional or vitamin deficiencies
• 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.
• Nasogastric suction -- a nasogastric (NG) tube is placed through the nose into the stomach to remove air from (decompress) the bowel.
• Neostigmine may be used to treat intestinal pseudo-obstruction that is only in the large bowel (Ogilvie's syndrome)
• Special diets usually do not work, although vitamin B12 and other vitamin supplements should be used for patients with vitamin deficiency.
• Stopping any medication that may have caused the problem (such as narcotic drugs)

In severe cases, surgery may be needed.

Outlook (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.

Possible Complications

• Diarrhea
• Rupture (perforation) of the intestine
• Vitamin deficiencies
• Weight loss

When to Contact a Medical Professional

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

Alternative Names

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

References

Andrews JM, Blackshaw LA. Small intestinal motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 97.

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 138.

Fry RD, Mahmoud NN, Maron DJ, Bleier JIS. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 52.

Update Date: 7/25/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.