A Rare Case of Chronic Small Bowel Pseudo-Obstruction

Abstract

Chronic small bowel pseudo-obstruction is rare, and the disease process is poorly understood. Its clinical picture and radiographic findings can resemble mechanical small bowel obstruction and may lead to unnecessary surgery. We report a case of a 68-year-old man who presented acutely with severe abdominal distension and pain after a recent laparoscopic adhesiolysis. His abdominal CT scan revealed grossly distended small bowel with pneumatosis intestinalis and free intraperitoneal air, which led to an exploratory laparotomy. He had a history of having undergone numerous radiological and endoscopic investigations and multiple laparotomies/laparoscopic procedures but without a definitive diagnosis. Subsequent episodes of small bowel pseudo-obstruction occurred, and he developed intestinal failure. His care required the input of multiple healthcare professionals. He was ultimately referred to the National Intestinal Failure Unit for further assessment and management.

Chronic Idiopathic Intestinal Pseudo-Obstruction

“…The management of CIPO requires coordinated efforts from a multidisciplinary team [ 6 ]. The main goals of treatment are to provide pain relief, increase GI motility, maintain good nutritional status, and prevent complications of motility loss such as bacterial overgrowth [ 7 ]. Medications can be used to control specific symptoms in individuals with CIPO [ 2 ].…”

The Impact of Microbiota on the Gut–Brain Axis: Examining the Complex Interplay and Implications

“…It is often misdiagnosed due to sub-occlusive episodes. Some of the neurological causes of pseudo-obstruction are pandysautonomia, pure autonomic failure, stroke, encephalitis, calcification of basal ganglia, myasthenia gravis, and autoimmune neuropathy [ 39 , 40 ]. Underlying processes include reduced ganglion cells, dysregulated stretch receptors, and suppression of parasympathetic action in the colonic smooth muscle [ 41 , 42 ].…”