Intestinal pseudo-obstruction
Intestinal pseudo-obstruction (IPO) is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen. Clinical features mimic those seen with mechanical intestinal obstructions and can include abdominal pain, nausea, abdominal distension, vomiting, dysphagia and constipation depending upon the part of the gastrointestinal tract involved.
| Intestinal pseudo-obstruction | |
|---|---|
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| Specialty | Gastroenterology |
| Symptoms | Abdominal pain, nausea, distention, vomiting, dysphagia, and constipation |
| Complications | Intestinal failure, malabsorption, nutrient deficiencies, small intestinal bacterial overgrowth |
| Duration | Varies according to etiology of disease. < 6 months is considered acute |
| Causes | Idiopathic, Kawasaki disease, Parkinson's disease, Chagas disease, Hirschsprung's disease, intestinal hypogangliosis, collagen vascular disease, mitochondrial disease, endocrine disorders, medication side effects |
| Diagnostic method | Signs and symptoms consistent with a mechanical intestinal obstruction with no identifying lesion. |
| Differential diagnosis | Intestinal obstruction, Crohn's disease, ovarian torsion, ovarian cyst, neoplasm, infection (parasitic) |
| Treatment | Aimed at management of complications (e.g. nutrition, hydration, pain relief). |
| Prognosis | 10–25% mortality rate in chronic cases |
| Frequency | Unknown |
It is a difficult condition to diagnose, requiring exclusion of any other mechanical cause of obstruction. Many patients are diagnosed late in the course of disease after additional symptoms are seen. Mortality is also difficult to accurately determine. One retrospective study estimated mortality to be between 10 and 25% for chronic intestinal pseudo-obstruction (CIPO) and to vary greatly depending on the etiology of the condition. When present for less than six months, it is diagnosed as acute IPO or Ogilvie syndrome. Longer than this is considered chronic. Owing to the difficulty of diagnosis, few studies are available which have attempted to estimate its prevalence.
The condition can begin at any age. Most studies describing CIPO are in pediatric populations. It can be a primary condition (idiopathic or inherited) or caused by another disease (secondary). It can be a result of myriad of etiologies including infectious, parasitic, autoimmune, genetic, congenital, neurologic, toxic, endocrinological, or anatomical pathology.
Treatment targets nutritional support, improving intestinal motility, and minimizing surgical intervention. Bacterial overgrowth of the small intestine can occur in chronic cases – presenting as malabsorption, diarrhea, and nutrient deficiencies – which may require the use of antibiotics.