Intestinal Pseudo – Obstruction
Intestinal pseudo obstruction is a very rare incidence and may affect people of all age.It commonly affect children rather than adults. The patient presented with the symptoms of intestinal blockage like not passing stool or flatus for few days, abdominal distension and vomiting. In pseudo intestinal obstruction, no mechanical obstruction found during examination. Long term or chronic intestinal pseudo obstruction mainly affect children and usually present at birth.Some cases may be associated with X-linked disease or autosomal recessive. Another form of pseudo intestinal obstruction occur when the colon become enlarge after surgical procedures or severe illness. This condition is called acute pseudo intestinal obstrcution and mainly seen in adults.
The aetiology of the disease is the lacking of normal intestinal motility. This is a result of the intestinal neuromusculature abnormality either the nerves or muscles. In some cases, it is due to autoimmune disease. If the causes of the pseudo obstruction, it is called primary or idiopathic. If the cause is kown, it is called secondary pseudo obstruction. Some secondary causes iclude abdominal or pelvic surgery, infections and medications ( i.e.: opiates and antidepressants -affect muscles ad nerves). Some diseases that affect muscles and nerves also may lead to secondary pseudo obstruction. This includes lupus erythematosus, scleroderma and Parkinson’s disease.
Clinical features that may be seen are abdominal distension, constipation and vomiting. Other symptoms include nausea, bloating and abdominal cramps. Occasionally, the patient may present with diarrhea. Some of the children may present with failure to thrive while older patients may present wit malnourish and weight loss. Apart of clinical symptoms that is very important for the diagnosis, some investigations are needed to confirm the diagnosis. Histoligicaly, full thickness intestinal biopsy is needed to assess abnormalities of intestinal smooth muscle and nerve plexus. Intestinal manometry should be carried out to measure the patterns of intestinal contractions.
Treatment is mainly supportive. The patients mainly need nutritional support to prevent malnutrition and weight loss. The patient may need overnight continuous liquid enteral feeds to absorb sufficient nutriens. The enteral fluid may be given through feeding tube that is inserted throught the nose direct to thee stomachor small intestine. The most severe affected patients may require parenteral nutrition ( the food in fluid form will be directly given to the patients via large venous access) to provide their nutrition needs. The mainstay of treatment is to treat the underlying causes if the cause is known and treatable. Some medications like antibiotics and pain relief might be useful especially if the problem is complicated by bacterial infcetions. In some patients (like acute pseudo intestinal obstruction), some procedures may be needed to remove the gas from the bowel. In severe cases, surgical interventions is indicated to remove part the affected intestine.
Long term prognosis are not that good where chronic relapasing is anticipated. The disease may recurrent and persist over many years.
Reference:
1) The Great Ormond Street Colour Handbook of Paediatrics and child Health. Manson Publishing. 2007.
2) http://digestive.niddk.nih.gov/ddiseases/pubs/intestinalpo/index.htm
3)http://health.allrefer.com/health/primary-or-idiopathic-intestinal-pseudo-obstruction-prognosis.html
Tags: abdominal distension, constipation, intestinal, lupus erythematosus, Parkinson's disease, pseudo obstruction, scleroderma, vomiting
Technorati Tags: abdominal distension, constipation, intestinal, lupus erythematosus, Parkinson's disease, pseudo obstruction, scleroderma, vomiting
Thank you for this very informative article. I I just knew about intestinal pseudo-obstruction in here and I’ve learned a lot especially the fact that this disease affects people of all ages but most affected are the young one’s. It is really important to have some knowledge and awareness about this particular disease.
Very informative article!
I was not aware of many of the things that you provided about Intestinal pseudo obstruction!
Thank you for posting!
Amazing post!
With this post I can alert own self.
Awesome information.it is very useful information. Thanks for sharing with us..
Thank You..
Multiple air fluid levels in the X ray is tall tale sign of intestinal obstructions.
in my opinion your post could have in even better with an X Ray.
Thanks
Dr Kingston
My wife has had this condition since our second child was born 3years ago
her mother, aunts and grandmother had it too and we are all trying to better alternatives than tpn
if anyone knows please help
rgds
Matthew
hong kong