Small Bowel Pseudo-obstruction Research Articles

The Role of Increasing Serum C-reactive Protein Level in Diagnosis of Post-surgery Small Bowel Pseudo-obstruction: A Case Report

Introduction: Acute colonic pseudo-obstruction (APCO), which is identified as colon dilatation without any mechanical obstruction, is a rare post-surgery complication. Case Presentation: Herein, we report a 40-year-old woman who underwent total laparoscopic hysterectomy with no complications during the surgery. On post-op visits, she complained of vague abdominal pain, especially in the upper quadrants, with a mild abdominal distention on her physical examination. Despite normal abdominal imaging, C-reactive protein (CRP) level was rising. Although oral intake was discontinued, the abdominal distention progressed gradually, and CRP levels rose continuously. On the fifth post-surgery day, the patient was suffering from bilious vomiting. Additionally, the abdominal distention was accompanied by tenderness. Emergency laparotomy was scheduled for clinically suspected bowel problems that were resistant to conservative management. During emergency laparotomy, the small bowel was distended. Since 20 cm of ileum was ischemic due to bowel congestion, segmental resection and anastomosis were performed. Conclusions: The CRP value can help to predict latent complications. It is also necessary to observe these patients closely to detect and manage probable post-operation complications.

S3028 A Difficult Diagnosis of Scleroderma-Related Small Bowel Pseudo-Obstruction With Radiographic Transition Point

S3028 A Difficult Diagnosis of Scleroderma-Related Small Bowel Pseudo-Obstruction With Radiographic Transition Point

Small Bowel Dysmotility, Pseudoobstruction, and Functional Correlation with Histopathology: Lessons Learned.

Small bowel dysmotility is a broad heterogeneous term that encompasses a wide range of gastrointestinal disorders resulting from abnormal gut motility. Chronic intestinal pseudo-obstruction (CIPO) is a severe, rare, and complex small bowel motility disorder at the extreme end of this spectrum. It is characterized by failure of the intestinal tract to propel contents, which results in signs and symptoms of bowel obstruction albeit in the absence of any obstructive lesion(s). In this article, we discuss up-to-date diagnostic techniques, management options, and histopathological findings in CIPO. We will emphasize the latest diagnostic methodologies and therapeutic options as well as enteric histopathologic abnormalities in patients with CIPO. CIPO continues to be a clinical challenge. Several novel pharmacological agents hold promise including gastrointestinal hormone agonists and prokinetics. Furthermore, histopathologic findings may help guide therapy and provide further prognostic significance. At present, nutritional support, symptom management, and avoidance of long-term complications are the mainstay of treatment in CIPO.

3220 Systemic Sclerosis Leading to Recurrent Small Bowel Pseudo-Obstruction

INTRODUCTION: Systemic sclerosis (SSc) is a chronic systemic disease defined by early microvascular obliterative changes, early activation of T and B-lymphocytes, and extensive fibrosis of the skin and internal organs. Although gastrointestinal involvment of SSc is common, severe intestinal disease manifested by malabsorption, recurrent pseudo-obstruction, or need for parenteral nutrition carries a poor prognosis and is seldom seen. We present the uncommon case of a patient with severe scleroderma bowel causing debilitating disease. CASE DESCRIPTION/METHODS: A 76-year-old female with history of atrial fibrillation, systemic sclerosis, achalasia s/p Botox injections, and duodenal bulb ulcer presented to our institution with vomiting of blood-streaked emesis, epigastric abdominal pain, and distension for two days. She had multiple hospitalizations for presumed obstructions in the past treated medically. Endoscopy 3 months prior revealed a large cratered duodenal ulcer located at the duodenal sweep with recent stigmata of bleeding (Forrest Class IIa) treated with epinephrine. Upon evaluation the patient was afebrile and normotensive. Physical exam was significant for mild diffuse abdominal tenderness and no gross blood on rectal exam. Labs were remarkable for Hgb 11.9, MCV 92.8, lactic acid 1.0, and lipase within normal limits. CT A/P showed multiple dilated small bowel loops with air-fluid levels and a fluid-filled patulous esophagus that was unchanged. Trauma surgery was consulted and we managed the patient conservatively with bowel rest, IV fluids, and continuation of her PPI. Her clinical course improved and she was able to pass flatus and stool. We attributed her recurrent symptoms to intestinal pseudo-obstruction precipitated by scleroderma. DISCUSSION: SSc is a chronic autoimmune condition commonly affecting the gastrointestinal tract. Major manifestations of small intestinal involvement are due to reduced peristalsis, causing abdominal distension and pain from dilated bowel loops. Acute intestinal pseudo-obstruction is a medical emergency that warrants hospital admission. Most patients have spontaneous resolution with conservative measures like bowel rest, nasogastric decompression, and intravenous hydration but may require frequent readmissions. Surgery is discouraged due to risk of prolonged ileus or anastomotic failure although “venting” jejunostomy allows for air aspiration in chronic pseudo-obstruction. Recurrent intestinal pseudo-obstruction in these patients thus poses a therapeutic challenge.

Imaging Evidence Demonstrating Effectiveness of Osteopathic Visceral Manipulation Techniques in Treating Pseudo-Obstruction

Abstract This report describes the case of a 66-year-old afebrile woman seen on the hospital inpatient service with nausea, vomiting, bloating, and constipation for 5 days prior to admission. The patient was diagnosed with idiopathic acute small bowel pseudo-obstruction by gastroenterology. The epidemiology of acute small-bowel pseudo-obstruction is briefly reviewed. Osteopathic manipulative treatment (OMT) was performed on the patient using mostly abdominal and visceral manipulation techniques. This case represents the first report of imaging evidence that demonstrates the effectiveness of osteopathic visceral manipulation techniques in successfully treating patients who have acute intestinal pseudo-obstruction.

Systemic amyloidosis due to unknown multiple myeloma in small bowel pseudo-obstruction: case report

Amyloidosis is a pathologic diagnosis characterized by extracellular deposition of insoluble protein fibrils in various organs and tissues. There are two main forms of amyloidosis, primary amyloidosis, and secondary amyloidosis. Gastrointestinal involvement is common in both amyloidosis forms. We describe the case of a 78-year-old woman taken to the operating room for small bowel obstruction, found to have pseudo-obstruction and enteritis. Exploratory laparotomy revealed gastric mass and histological examen showed extensive amyloid deposition consistent with amyloidosis. Hematological evaluation revealed unknown multiple myeloma. This case report and literature data suggest to perform a hematological examination in patients with amyloidosis diagnosis to exclude a multiple myeloma or other plasma cell disorders

A Novel Use of N-Acetylcystine for the Management of Recurrent Small Bowel Pseudo-Obstruction in a Patient with Autoimmune Autonomic Ganglionopathy

A Novel Use of N-Acetylcystine for the Management of Recurrent Small Bowel Pseudo-Obstruction in a Patient with Autoimmune Autonomic Ganglionopathy

Fever Related to Fungemia Facilitated by Intralipid® Infusion

Purpose: A 62-year-old man with a history of small bowel pseudo-obstruction requiring long term total parenteral nutrition (TPN) with Intralipid® which he received via a tunneled central venous catheter presented to the clinic. He was well until approximately 6 weeks prior to admission when he developed fever and generalized malaise. He was hospitalized elsewhere on two prior occasions, treated empirically with antibiotics, and his blood cultures were negative. On his third admission, he had a catheter related bloodstream infection with Staphylococcus epidermidis requiring catheter exchange and intravenous antibiotics. Unfortunately, he presented again with his usual symptoms of fever, chills, and generalized malaise for a fourth time. Blood cultures were negative and he remained afebrile during hospitalization and was discharged home. During the admission, he was not given Intralipid® due to a nationwide shortage. At home, he developed fevers, but only on days he received Intralipid infusion. He was admitted a fifth time and blood cultures eventually grew Malassezia. His tunneled catheter was removed and he was treated with fluconazole. Malassezia species are lipophilic fungi that colonize the skin and can be associated with catheter related bloodstream infections, typically in the setting of TPN with Intralipid®. Specialized culture techniques utilizing sterilized lipid solutions are required to make the diagnosis, so a high index of suspicion must be maintained for patients receiving TPN and experiencing intermittent fevers.

Breath Testing for Small Intestinal Bacterial Overgrowth: Maximizing Test Accuracy

The diagnosis of small intestinal bacterial overgrowth (SIBO) has increased considerably owing to a growing recognition of its association with common bowel symptoms including chronic diarrhea, bloating, abdominal distention, and the irritable bowel syndrome. Ideally, an accurate and objective diagnosis of SIBO should be established before initiating antibiotic treatment. Unfortunately, no perfect test exists for the diagnosis of SIBO. The current gold standard, small-bowel aspiration and quantitative culture, is limited by its high cost, invasive nature, lack of standardization, sampling error, and need for dedicated infrastructure. Although not without shortcomings, hydrogen breath testing provides the simplest noninvasive and widely available diagnostic modality for suspected SIBO. Carbohydrates such as lactulose and glucose are the most widely used substrates in hydrogen breath testing, with glucose arguably providing greater testing accuracy. Lactose, fructose, and sorbitol should not be used as substrates in the assessment of suspected SIBO. The measurement of methane in addition to hydrogen can increase the sensitivity of breath testing for SIBO. Diagnostic accuracy of hydrogen breath testing in SIBO can be maximized by careful patient selection for testing, proper test preparation, and standardization of test performance as well as test interpretation.

Strangulated Small Bowel Obstruction Following Endoscopic Retrograde Cholangiopancreatography

Strangulated Small Bowel Obstruction Following Endoscopic Retrograde Cholangiopancreatography

Breath Hydrogen Gas Concentration Linked to Intestinal Gas Distribution and Malabsorption in Patients with Small-bowel Pseudo-obstruction

The patient with colonic obstruction may frequently have bacterial overgrowth and increased breath hydrogen (H2) levels because the bacterium can contact with food residues for longer time. We experienced two cases with intestinal obstruction whose breath H2 concentrations were measured continuously. CASE 1: A 70-year-old woman with small bowel obstruction was treated with a gastric tube. When small bowel gas decreased and colonic gas was demonstrated on the plain abdominal radiograph, the breath H2 concentration increased to 6 ppm and reduced again shortly. CASE 2: A 41-year-old man with functional small bowel obstruction after surgical treatment was treated with intravenous administration of erythromycin. Although the plain abdominal radiograph demonstrated a decrease of small-bowel gas, the breath H2 gas kept the low level. After a clear-liquid meal was supplied, fasting breath H2 concentration increased rapidly to 22 ppm and gradually decreased to 9 ppm despite the fact that the intestinal gas was unchanged on X-ray. A rapid increase of breath H2 concentration may reflect the movement of small bowel contents to the colon in patients with small-bowel pseudo-obstruction or malabsorption following diet progression. Change in breath H2 concentration had a close association with distribution and movement of intestinal gas.

Imaging in Intestinal Ischemic Disorders

Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel and/or colon. The incidence of bowel ischemia is increasing for a number of reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have contributed greatly to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes. In this review, advances in multidetector computerized tomography, magnetic resonance, and ultrasound in the detection of intestinal ischemia are highlighted and placed in the context of expeditious patient management.

Solifenacin‐induced small bowel pseudo‐obstruction

An 89-year-old woman was admitted to Johns Hopkins Hospital with a small bowel obstruction and symptoms of urinary retention. She had been started on solifenacin for bladder overactivity 10 days prior to her presentation. Withdrawal of the solifenacin resulted in a full recovery, which has persisted for greater than 6 months without surgical intervention. This is the first reported case report of small bowel pseudo-obstruction due to solifenacin.

Change in Breath Hydrogen Concentration Reflects Movement of Intestinal Gas in Patients with Small-Bowel Pseudo-Obstruction

Change in Breath Hydrogen Concentration Reflects Movement of Intestinal Gas in Patients with Small-Bowel Pseudo-Obstruction

Successful transanal direct percutaneous ileostomy for management of small bowel pseudo-obstruction after subtotal colectomy

Successful transanal direct percutaneous ileostomy for management of small bowel pseudo-obstruction after subtotal colectomy

Demonstration of varicella-zoster virus infection in the muscularis propria and myenteric plexi of the colon in an hiv-positive patient with herpes zoster and small bowel pseudo-obstruction (ogilvie’s syndrome)

Gastrointestinal symptomatology as a complication of herpes zoster (HZ) is extremely rare, with the majority of reported cases showing only temporal or radiological evidence of GI tract involvement by varicella zoster virus (VZV) infection. We present the first case of documented direct VZV infection in the muscularis propria of the gut presenting as intestinal pseudo-obstruction (Ogilvie’s syndrome). The patient was a 34-yr-old HIV+ man who developed small bowel pseudo-obstruction in association with disseminated cutaneous HZ. A partial ileocolectomy specimen demonstrated a focal ulcer in the terminal ileum. Immunohistochemistry against VZV gpI demonstrated diffuse staining of the muscularis propria and myenteric plexi throughout the length of the specimen. Viral particles consistent with Herpesviridae were shown to be present ultrastructurally. We postulate that the viral infection in the neuronal plexi and muscularis propria caused muscle injury leading to pseudo-obstruction.

Acute small bowel pseudo-obstruction due to AL amyloidosis: a case report and literature review

Amyloidosis may uncommonly present with intestinal pseudo-obstruction. Previous reports have described an acute presentation with AA amyloid and a more chronic syndrome with AL amyloid. We report the case of a 78-yr-old man who presented with clinical and radiographic features of an acute small bowel obstruction and who, at laparotomy, was found to have intestinal pseudo-obstruction due to AL amyloidosis. We believe this case represents the first report of acute pseudo-obstruction from AL amyloidosis; awareness of this presentation may facilitate earlier diagnosis.

Total nutritional manipulation in humans: report of acancer patient

We report here on a patient requiring home total parenteral nutrition (TPN) for a huge intra-abdominaldesmoid associated with chronic small bowel pseudo-obstruction who was kept on a special lipid-based calorie regimen for 5 months. The rationale was to attempt to feed the host with a minimal stimulation of tumour growth by using lipid as caloric substrate instead of glucose which is utilized by the tumour. Gluconeogenesis was tentatively inhibited at the level of phosphoenolpyruvate-carboxy-kinase through the oral intake of hydrazine sulphate. The regimen consisted of 28 non-protein lipid Kcal/kg/day plus 1.5 g amino acid per kg/day. Only a small amount of glucose (approx. 40 g/day) was allowed. Tolerance to the regimen was good and body weight maintained. Liver enzymes remained within the normal range and liver sonography was normal throughout the 5 months' therapy and there were no episodes of symptomatic hypoglycaemia. The tumour volume did not substantially change.

Small bowel pseudo-obstruction in Kawasaki disease: T. Miyake, J. Kawamori, T. Yoshida, et al. Pediatr Radiol 17:383–386, (May), 1987

Small bowel pseudo-obstruction in Kawasaki disease: T. Miyake, J. Kawamori, T. Yoshida, et al. Pediatr Radiol 17:383–386, (May), 1987

Roentgenographic findings of experimental bowel ischaemia is dogs following occlusion of the superior mesenteric artery (author's transl)

The results after ligation of the superior mesenteric artery in 17 dogs demonstrated, that a "gasless" abdomen and small bowel pseudo-obstruction are unspecific early roentgenographic findings and bowel-wall thickening with narrowed lumen and increased distance to neighbouring loops are a specific early roentgenographic plain-film findings of acute bowel ischemia following mesenteric vascular occlusion. Approximately 10 hours after ligation a combined distension of small and large bowel with dilatation and air-fluid levels is demonstrable as a sign of paralytic ileus with diffuse peritonitis without possibility of differentiation from other causes of this entity. Gas in the bowel wall, in the superior mesenteric vein and in the portal venous system is a late specific plain-film finding resulting from the invasion of gas-forming bacteria into the devitalized bowel wall with advanced gangrene and a sign of infaust prognosis. The results of the plain-film examinations are correlated to angiographic, clinical and laboratory findings, as well as to histology and bacteriology of the ischemic bowel segments.