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Intestinal pseudo-obstruction

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

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

Causes

In intestinal pseudo-obstruction, the intestine is unable to contract and push food, stool, and air through the digestive tract. The disorder most often affects the small intestine, but can also occur in the large intestine.

The condition may start suddenly or be a chronic or long-term problem. It is most common in children and older people. The cause of the problem is often unknown.

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 drugs that slow intestinal movements. These include narcotic (pain) medicines and drugs used when you are not able to keep urine from leaking out.

Symptoms

Symptoms include:

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
  • Antroduodenal manometry
  • Gastric emptying radionuclide scan
  • Intestinal radionuclide scan

Treatment

The following treatments may be tried:

  • 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 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).
  • Special diets often do not work. However, vitamin B12 and other vitamin supplements should be used for people with vitamin deficiency.
  • 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.

Possible Complications

Complications may include:

When to Contact a Medical Professional

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

References

Andrews JM, Brierley SM, Blackshaw LA. Small intestinal motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 96.

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 136.

Fry RD, Mahmoud NN, Maron DJ, Bleier JIS. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

      • Digestive system organs

        Digestive system organs - illustration

        The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

        Digestive system organs

        illustration

      Review Date: 5/11/2016

      Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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