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Chronic Intestinal Pseudo-obstruction

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Functional and Motility Disorders of the Gastrointestinal Tract

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Abstract

Intestinal pseudo-obstruction can be categorized as either acute or chronic. Chronic intestinal pseudo-obstruction (CIP) differs clinically from acute intestinal pseudo-obstruction by the presence of obstructive symptoms for at least 6 months. CIP is a rare yet debilitating neuromuscular disorder of the gastrointestinal tract characterized by impaired peristalsis with symptoms and imaging that may mimic mechanical bowel obstruction. Because the symptoms of CIP including abdominal pain, nausea, vomiting, bloating, and abdominal distension are nonspecific, CIP often goes undiagnosed for many years despite multiple potentially dangerous diagnostic tests and treatments. Thus, a high degree of clinical suspicion in conjunction with a careful history and physical examination remains paramount to establishing the diagnosis. Importantly, CIP is not a single disorder; rather, it refers to a heterogeneous group of disorders characterized by disordered intestinal peristalsis.

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Key References

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue/A31, Cleveland, OH, 44195, USA

    Scott Gabbard M.D.

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise M.D.

Authors
  1. Scott Gabbard M.D.
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  2. John K. DiBaise M.D.
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Corresponding author

Correspondence to Scott Gabbard M.D. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

    Brian E. Lacy

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA

    Michael D. Crowell

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA

    John K. DiBaise

Teaching Questions

Teaching Questions

  1. 1.

    An 18-year-old male presents with 2 years of nonprogressive chronic nausea, vomiting, distension, and abdominal pain. An upright abdominal X-ray is notable for dilated small intestine. Which one of the following is the best next step in the evaluation for CIP?

    1. (A)

      Celiac serologies

    2. (B)

      Upper endoscopy

    3. (C)

      Antinuclear antibody

    4. (D)

      MR enterography

  2. 2.

    A 45-year-old female with CIP and gastroparesis has lost 15 lb (10 % of body weight) over the past 6 months due to reduced oral intake resulting from chronic pain, nausea, and vomiting. Which one of the following is the next best step in nutrition management?

    1. (A)

      Placement of Hickman catheter to initiate parenteral nutrition

    2. (B)

      Endoscopic placement of a gastrostomy tube for venting

    3. (C)

      Trial of nasojejunal feeding

    4. (D)

      Partial gastrectomy

  3. 3.

    A 32-year-old male with CIP requiring parenteral nutrition for the past 3 years has suffered multiple central line infections and urinary tract infections over the past year. Which one of the following evaluations would not be required before undergoing small bowel transplantation?

    1. (A)

      Urology referral

    2. (B)

      Colonoscopy

    3. (C)

      Hepatic function testing

    4. (D)

      Gastric emptying scan

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Gabbard, S., DiBaise, J.K. (2015). Chronic Intestinal Pseudo-obstruction. In: Lacy, B., Crowell, M., DiBaise, J. (eds) Functional and Motility Disorders of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1498-2_12

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  • DOI: https://doi.org/10.1007/978-1-4939-1498-2_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1497-5

  • Online ISBN: 978-1-4939-1498-2

  • eBook Packages: MedicineMedicine (R0)

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