Chronic Idiopathic Intestinal Pseudo-Obstruction.

Xuanzhen Piao,Michael J Chaney,Farah Zahra,Shirly Samuel,Grace W Ying,Artem Sharko

doi:10.7759/cureus.16563

Abstract

Chronic intestinal pseudo-obstruction (CIPO) is a rare, potentially debilitating gastrointestinal (GI) condition characterized by symptoms of intestinal obstruction with the absence of anatomic lesions. In this report, we present a case of an 86-year-old female who presented with severe abdominal discomfort, nausea, and vomiting for two weeks prior to presentation. Imaging studies revealed severe gastric distension with a lack of anatomic lesions. The patient was ultimately diagnosed with chronic idiopathic intestinal pseudo-obstruction (CIIP). The purpose of this case report is to raise awareness of this condition in the medical literature and discuss the epidemiology, pathophysiology, clinical manifestations, diagnostic workup, and treatment options of this disorder.

Highlights

Chronic intestinal pseudo-obstruction (CIPO) is defined as mechanical bowel obstruction in the absence of an organic lesion
It can present with various clinical pictures depending on the site in which there is loss of motility from muscle or nerve abnormalities, but it is commonly manifested as noncolicky abdominal pain and distension aggravated by food intake
Clinical manifestation of CIPO mainly depends on its location and extension within the GI tract

Summary

Introduction

Chronic intestinal pseudo-obstruction (CIPO) is defined as mechanical bowel obstruction in the absence of an organic lesion. While CIPO is not considered an acutely dangerous disease, the symptoms and difficulty in achieving adequate nutritional status can be debilitating for patients In this case, we report an elderly female who presented to the emergency department with two weeks of abdominal pain, nausea, and vomiting. The patient is an 86-year-old woman without significant past medical history who presented to the emergency department with a complaint of severe epigastric discomfort accompanied by intermittent nausea and vomiting for two weeks before presentation She stated that she was having persistent painless abdominal bloating. Given the acuity and severity of the situation, as she could no longer keep any solid or liquid down without vomiting, conservative management was not started Instead, she underwent exploratory laparotomy, mobilization of the duodenum with Kocher maneuver, and gastrojejunostomy with surgical biopsies negative for primary duodenal or ampullary malignancy. She had good pain control with oral medications, tolerated a low-fiber diet, had a complete return of bowel function, and was subsequently discharged home on tramadol as needed

Discussion

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Disclosures