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.
Highlights
Chronic intestinal pseudo-obstruction (CIPO) is a rare disease characterised by the inability of the intestinal tract to propel its contents, resulting in a clinical presentation very similar to intestinal obstruction, but in the absence of any obstructive lesion in the gut [1,2,3]
CIPO is an important cause of intestinal failure, which is associated with high morbidity and mortality [1]
We present a case of a 68-year-old man diagnosed with chronic small bowel pseudo-obstruction resulting in intestinal failure
Summary
Chronic intestinal pseudo-obstruction (CIPO) is a rare disease characterised by the inability of the intestinal tract to propel its contents, resulting in a clinical presentation very similar to intestinal obstruction, but in the absence of any obstructive lesion in the gut [1,2,3]. A 68-year-old man with a history of abdominal pain of unknown cause despite numerous radiological and endoscopic investigations by a gastroenterologist underwent a laparotomy in 2008 This revealed dilatation of the entire small bowel up to 12 cm until two feet from the ileocaecal valve with the collapsed large bowel; no mechanical cause was found to explain the small bowel distension. The patient was managed with home parenteral nutrition and after several months, his ileostomy was reversed He subsequently developed two further episodes of small bowel pseudoobstruction which were managed conservatively in our hospital over the last two years
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