Drexel University College of Medicine

Diseases and Conditions

Primary intestinal pseudo-obstruction

Definition

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

Alternative Names

Causes, incidence, and risk factors

In primary intestinal pseudo-obstruction, the small or large intestines lose their ability to contract and push food, stool, and air through the gastrointestinal tract.

The condition can occur suddenly (acute) or over time (chronic). It may occur at any age, but is most common in children and the elderly. Because the cause is unknown, it is also called idiopathic intestinal pseudo-obstruction (idiopathic means occurring without reason).

Risk factors include:

• Having cerebral palsy or other nervous system (neurologic) disorders
• Staying in bed for long periods of time (bedridden)
• Taking narcotic (pain) medications

Symptoms

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

Signs and tests

Signs include:

• Malabsorption

Tests include:

• Abdominal x-ray
• Barium swallow or barium enema
• Esophageal manometry
• Intestinal radionuclide scan

Treatment

• A medication called neostigmine may be used to treat pseudo-obstruction of the large intestine.
• Colonoscopy may be used to remove air from the intestine.
• Fluids given through a vein (intravenous fluids) will replace fluids lost from vomiting or diarrhea.
• Nasogastric suction -- a nasogastric (NG) tube is placed thru the nose into the stomach to remove air from (decompress) the bowel.
• Special diets usually do not work, although vitamin B12 supplements may be used for patients with vitamin deficiency.

In severe cases, surgery may be needed.

Expectations (prognosis)

Most cases of acute pseudo-obstruction get better in a few days with treatment. The disease may return, and can continue for many years.

Complications

• Diarrhea
• Vitamin deficiencies
• Weight loss

Calling your health care provider

Call your health care provider if you have persistent abdominal pain or other symptoms of this disorder.

References

Batke M, Cappell MS. Adynamic ileus and acute colonic pseudo-obstruction. Med Clin North Am. 2008;92:649-670.

Talley NJ. Functional Gastrointestinal Disorders: Irritable Bowel Syndrome, Dyspepsia, and Noncardiac Chest Pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 139.

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