- Intestinal pseudoobstruction
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Intestinal pseudoobstruction Classification and external resources ICD-9 560.89 OMIM 155310 DiseasesDB 10868 eMedicine med/2699 med/3570 MeSH D003112 Intestinal pseudoobstruction is decreased ability of the intestines to push food through, and often causes dilation of various parts of the bowel. It can be a primary condition (idiopathic or inherited) or caused by another disease (secondary). The clinical and radiological findings are often similar to true intestinal obstruction.
It can be chronic[1] or acute.[2]
Contents
Causes
There is some evidence of a genetic association.[3] One form has been associated with DXYS154.[4]
It can occur in conjunction with Kawasaki disease[5] or Parkinson's disease.
Clinical manifestations
People with pseudoobstruction have abdominal pain, diarrhea, or constipation. In addition, their abdominal x-ray shows dilated loops of bowel. All of these features are also seen in true mechanical obstruction of the bowel.
Diagnosis
Attempts must be made to find the underlying cause of intestinal pseudoobstruction. Secondary intestinal pseudoobstruction may be caused by scleroderma (esophageal motility is also impaired), myxedema, amyloidosis, muscular dystrophy, multiple sclerosis, hypokalemia, chronic renal failure, diabetes mellitus, drugs (anticholinergics, opiates)
Primary (idiopathic) intestinal pseudoobstruction diagnosed based on motility studies, x-rays, and gastric emptying studies. It may be caused by problems with the smooth muscle of the intestines (hollow visceral myopathy), or may be caused by problems with the nerves that supply the gut.
Treatment
Secondary pseudoobstruction is managed by treating the underlying condition.
There is no cure for primary pseudoobstruction. It is important that nutrition and hydration is maintained, and pain relief is given. Drugs that increase the propulsive force of the intestines have been tried, as have different types of surgery.
Medical treatment
Metoclopramide, cisapride, and erythromycin may be used, but they have not been shown to have great efficacy. In such cases, treatment is aimed at managing the complications.
Intestinal stasis, which may lead to bacterial overgrowth, and, subsequently, diarrhea or malabsorption is treated with antibiotics.
Nutritional deficiencies can be treated with oral supplements, and, rarely, total parenteral nutrition.
Use of octreotide has been described.[6][7]
Surgical and other procedures
Intestinal decompression by colostomy or tube placement in a small stoma can also be used to reduce distension and pressure within the gut. The stoma may a gastrostomy, enterostomy or cecostomy, and may also be used to feed or flush the intestines.
Colostomy or ileostomy can bypass affected parts if they are distal to (come after) the stoma. For instance, if only the large colon that is affected, an ileostomy may be helpful.
Resection of affected parts may be needed if part of the gut dies (for instance toxic megacolon), or if there is a localised area of dysmotility.
Gastric and colonic pacemakers have been tried. These are strips placed along the colon which create an electric discharge intended to cause the muscle to contract in a controlled manner.
A potential solution, albeit radical, is a multi-organ transplant. The operation involved transplanting the pancreas, stomach, duodenum, small intestine, and liver, and was performed by Doctor Kareem Abu-Elmagd on Gretchen Miller, the subject of the Discovery Channel program Surgery Saved My Life.[8]
Related disorders
- Ogilvie syndrome: acute pseudoobstruction of the colon in severely ill debilitated patients.
- Hirschsprung's disease: enlargement of the colon due to lack of development of autonomic ganglia.
- Intestinal neuronal dysplasia: a disease of motor neurons leading to the bowels.
- Bowel obstruction: mechanical or functional obstruction of the bowel most commonly due to adhesions, hernias or neoplasms.
- Enteric neuropathy: alternative name sometimes used for diagnosis in UK
References
- ^ Sutton DH, Harrell SP, Wo JM (February 2006). "Diagnosis and management of adult patients with chronic intestinal pseudoobstruction". Nutr Clin Pract 21 (1): 16–22. doi:10.1177/011542650602100116. PMID 16439766. http://ncp.sagepub.com/cgi/pmidlookup?view=long&pmid=16439766.
- ^ Saunders MD (October 2004). "Acute colonic pseudoobstruction". Curr Gastroenterol Rep 6 (5): 410–6. doi:10.1007/s11894-004-0059-5. PMID 15341719.
- ^ Guzé CD, Hyman PE, Payne VJ (January 1999). "Family studies of infantile visceral myopathy: a congenital myopathic pseudo-obstruction syndrome". Am. J. Med. Genet. 82 (2): 114–22. doi:10.1002/(SICI)1096-8628(19990115)82:2<114::AID-AJMG3>3.0.CO;2-H. PMID 9934973.
- ^ Auricchio A, Brancolini V, Casari G, et al. (April 1996). "The locus for a novel syndromic form of neuronal intestinal pseudoobstruction maps to Xq28". Am. J. Hum. Genet. 58 (4): 743–8. PMC 1914695. PMID 8644737. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1914695.
- ^ Akikusa JD, Laxer RM, Friedman JN (May 2004). "Intestinal pseudoobstruction in Kawasaki disease". Pediatrics 113 (5): e504–6. doi:10.1542/peds.113.5.e504. PMID 15121996. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=15121996.
- ^ Sharma S, Ghoshal UC, Bhat G, Choudhuri G (November 2006). "Gastric adenocarcinoma presenting with intestinal pseudoobstruction, successfully treated with octreotide". Indian J Med Sci 60 (11): 467–70. doi:10.4103/0019-5359.27974. PMID 17090868. http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2006;volume=60;issue=11;spage=467;epage=470;aulast=Sharma.
- ^ Sørhaug S, Steinshamn SL, Waldum HL (April 2005). "Octreotide treatment for paraneoplastic intestinal pseudo-obstruction complicating SCLC". Lung Cancer 48 (1): 137–40. doi:10.1016/j.lungcan.2004.09.008. PMID 15777981. http://linkinghub.elsevier.com/retrieve/pii/S0169-5002(04)00471-4.
- ^ Discovery Channel - Multiorgan transplant
External links
Categories:- Diseases of intestines
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