7 - Recurrent or Chronic Intestinal Pseudo-obstruction

Abstract

Recurrent or chronic intestinal pseudo-obstruction is not a rare problem. More cases will be recognized and diagnosed when clinicians are more aware of this problem. Medical treatment is unsatisfactory in most cases unless the patients have such treatable associated systemic diseases as myxoedema, hypoparathyroidism or phaeochromocytoma. Intermittent antibiotic therapy may be needed to alleviate diarrhoea or steatorrhoea due to bacterial overgrowth in the small intestine. Surgery may help to relieve the symptoms in those cases with short segmental dilatation of the bowel. Most patients will have an exploratory laparotomy to rule out an organic obstructing lesion. Either a drainage procedure or resection of a short dilated segment should be carried out. Once the diagnosis of chronic intestinal pseudo-obstruction is made, repeated exploratory operations must be avoided. Preoperative antibiotic therapy to treat bacterial overgrowth in the small bowel will reduce postoperative peritonitis from peritoneal soiling by septic small bowel contents.