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Intestinal pseudo-obstruction

Intestinal pseudo-obstruction is a condition in which there are symptoms of intestinal blockage without any physical blockage.

Alternative Names

Primary intestinal pseudo-obstruction; Acute colonic ileus; Colonic pseudo-obstruction; Idiopathic intestinal pseudo-obstruction; Ogilvie's syndrome; Chronic intestinal pseudo-obstruction

Causes

In primary intestinal pseudo-obstruction, the intestine is unable to contract and push food, stool, and air through the gastrointestinal tract. The disorder most often affects the small intestine, but can also occur in the large intestine.

The condition may come on suddenly (acute) or over time (chronic). It is most common in children and the elderly. The cause of the problem is unknown. Therefore, it is also called idiopathic intestinal pseudo-obstruction. Idiopathic means occurring without a known reason.

Risk factors include:

  • Cerebral palsy or other nervous system (neurologic) disorders
  • Chronic kidney, lung, or heart disease
  • Staying in bed for long periods of time (bedridden)
  • Taking narcotic (pain) medicines or other drugs that slow intestinal movements (often called anticholinergic drugs)

Symptoms


Exams and Tests

During a physical exam, the health care provider will most often see abdominal bloating.

Tests include:

  • Abdominal x-ray
  • Anal manometry
  • Barium swallow , barium small bowel follow-through, or barium enema
  • Blood tests for nutritional or vitamin deficiencies
  • Colonoscopy
  • CT ("Cat") scan
  • Antroduodenal manometry
  • Gastric emptying radionuclide scan
  • Intestinal radionuclide scan

Treatment


  • Colonoscopy may be used to remove air from the large intestine.
  • Fluids can be given through a vein (intravenous fluids) to replace fluids lost from vomiting or diarrhea.
  • Nasogastric suction involving a nasogastric (NG) tube placed through the nose into the stomach can be used to remove air from (decompress) the bowel.
  • Neostigmine may be used to treat intestinal pseudo-obstruction that is only in the large bowel (Ogilvie's syndrome).
  • Special diets often do not work. However, vitamin B12 and other vitamin supplements should be used for patients with vitamin deficiency.
  • Stopping the medicines that may have caused the problem (such as narcotic drugs) may help.

In severe cases, surgery may be needed.

Outlook (Prognosis)

Most cases of acute pseudo-obstruction get better in a few days with treatment. In chronic forms of the disease, symptoms can come back and get worse over many years.

Possible Complications


  • Diarrhea
  • Rupture (perforation) of the intestine
  • Vitamin deficiencies
  • Weight loss

When to Contact a Medical Professional

Call your health care provider if you have abdominal pain that does not go away or other symptoms of this disorder.

References

Andrews JM, Blackshaw LA. Small intestinal motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Saunders Elsevier; 2010:chap 97.

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 138.

Fry RD, Mahmoud NN, Maron DJ, Bleier JIS. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 52.

Updated: 8/11/2014

Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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