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Intestinal pseudo-obstruction

Definition

Intestinal pseudo-obstruction is a condition in which there are symptoms of blockage of the intestine (bowels) without any physical blockage.

Alternative Names

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

Causes

In intestinal pseudo-obstruction, the intestine does not contract and push food, stool, and air through the digestive tract. The chronic disorder most often affects the small intestine, but can also occur in the large intestine (colon). The acute disorder usually affects the large intestine.

The condition may start suddenly or be a chronic or long-term problem. Sudden onset is called acute intestinal pseudo-obstruction and usually affects the small intestine and often other parts of the digestive tract. Chronic intestinal pseudo-obstruction usually affects the large intestine (colon.) It is most common in children and older people. The cause of the problem is often unknown. However, problems with the bowel's muscles or nerves may be a cause.

Risk factors include:

• Cerebral palsy or other brain or nervous system disorders.
• Chronic kidney, lung, or heart disease.
• Staying in bed for long periods of time (bedridden).
• Taking medicines that slow intestinal movements. These include narcotic (pain) medicines and medicines used when you are not able to keep urine from leaking out.
• After surgery

Symptoms

Symptoms include:

• Abdominal pain
• Bloating
• Constipation
• Nausea and vomiting
• Swollen abdomen (abdominal distention)
• Weight loss

Exams and Tests

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

Tests include:

• Abdominal x-ray
• Anorectal manometry
• Barium swallow, barium small bowel follow-through, or barium enema
• Blood tests for nutritional or vitamin deficiencies
• Colonoscopy
• CT scan of the abdomen
• MRI of the abdomen
• Antroduodenal manometry
• Gastric emptying radionuclide scan
• Intestinal radionuclide scan

Treatment

The following treatments may be tried:

• Moving around (walking, changing position in bed)
• Colonoscopy may be used to remove air from the large intestine.
• Fluids can be given through a vein to replace fluids lost from vomiting or diarrhea.
• Nasogastric suction involving a nasogastric (NG) tube placed through the nose into the stomach or small intestine, or a tube through the rectum into the large intestine can be used to remove air from the bowel.
• Neostigmine may be used to treat intestinal pseudo-obstruction that is only in the large bowel (Ogilvie syndrome).
• Other medicines may be tried
• Special diets often do not work. However, vitamin B12 and other vitamin supplements should be used for people with vitamin deficiency.
• Correcting blood disturbances such as low potassium and others
• Rarely a tube to vent the intestine is placed in the first part of the large intestine (cecum)
• 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.

If the intestine dilates severely, a hole in the bowel (perforation) may occur and surgical removal of the involved bowel may be needed. This may result in an ostomy (attaching the bowel to the abdomen and stool passes into a bag. If malnutrition happens, you may need to be fed through a tube or the vein. Other parts of the GI tract may also have problems from poor contraction.

Possible Complications

Complications may include:

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

When to Contact a Medical Professional

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

References

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 122.

Rayner CK, Hughes PA. Small intestinal motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 99.

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