Functional colonic obstruction in an adult as a presenting feature of thymoma

Abstract

Functional colonic obstruction is a colonic motility disorder with a number of causes. One cause is myenteric ganglionitis, which may result from paraneoplastic processes. We present the case of a previously healthy 53-year-old man who presented with a week's history of functional colonic obstruction. A transverse loop colostomy failed to resolve his symptoms and he subsequently underwent an extended right hemicolectomy. Histology demonstrated lymphocytic myenteric ganglionitis that was felt to be of paraneoplastic origin. The patient later developed bilateral ptosis and was diagnosed with ocular myasthenia gravis. Further investigation revealed the presence of a thymoma that was resected, resulting in an improvement to his symptoms. We present this case and a review of the literature to illustrate the importance of seeking out a paraneoplastic cause for functional colonic obstruction in adults as early resection of the tumour may help alleviate symptoms and avoid bowel surgery.

Chronic Intestinal Pseudo-Obstruction Due to Incidentally Found Thymoma

“…Malhotra et al successfully treated a patient with thymoma and AP-CIPO with an extended right hemicolectomy when the patient failed to respond to transverse loop colostomy. 11 Our patient was treated with methylprednisolone, pyridostigmine, and a thymectomy, which led to symptom resolution. This approach has been recommended for thymoma-related AP-CIPO because it shares myasthenic features for which combination therapy improves symptoms at the neuromuscular junction and, thus, the gastrointestinal motility.…”

Autoimmune disorders and paraneoplastic syndromes in thymoma

“…Autoantibodypatterns include VGKC as well as neuronal AChR as targets. Prokinetic agents (i.e., pyridostigmine) and immunosuppressive therapies (corticosteroids, intravenous immunoglobulins) were utilized (85)(86)(87)(88)(89).…”