Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1980 Dec;192(6):752–761. doi: 10.1097/00000658-198012000-00011

Chronic idiopathic intestinal pseudo-obstruction. A surgical approach.

M D Schuffler, E A Deitch
PMCID: PMC1344976  PMID: 7447530

Abstract

Chronic idiopathic intestinal pseudo-obstruction is an increasingly recognized syndrome in which patients usually present with an acute or chronic history suggestive of intestinal obstruction, although no obstructing lesion is found at surgery. The diagnosis can be suspected in most cases from the clinical presentation. A diagnostic evaluation should be undertaken and exploratory laparotomy avoided if the diagnosis is confirmed on the basis of the radiographic and manometric data. If, in the acute presentation, exploratory laparotomy proves unavoidable, and dilated, nonmechanically obstructed bowel is found, a full-thickness biopsy specimen should usually be taken and the abdomen closed. A carefully chosen, palliative procedure should be reserved for patients who have well defined clinicoanatomic patterns of involvement, and who are incapacitated by their symptoms despite medical management.

Full text

PDF
755

Images in this article

753Fig. 1.
on p.753
755Fig. 2.
on p.755
755Fig. 3.
on p.755

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anuras S., Shirazi S., Faulk D. L., Gardner G. D., Christensen J. Surgical treatment in familial visceral myopathy. Ann Surg. 1979 Mar;189(3):306–310. doi: 10.1097/00000658-197903000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BARNETT W. O., WALL L. Megaduodenum resulting from absence of the parasympathetic ganglion cells in Auerbach's plexus; review of the literature and report of a case. Ann Surg. 1955 Apr;141(4):527–535. doi: 10.1097/00000658-195504000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dyer N. H., Dawson A. M., Smith B. F., Todd I. P. Obstruction of bowel due to lesion in the myenteric plexus. Br Med J. 1969 Mar 15;1(5645):686–689. doi: 10.1136/bmj.1.5645.686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. FISCHER H. W. The big duodenum. Am J Roentgenol Radium Ther Nucl Med. 1960 May;83:861–875. [PubMed] [Google Scholar]
  5. Faulk D. L., Anuras S., Christensen J. Chronic intestinal pseudoobstruction. Gastroenterology. 1978 May;74(5 Pt 1):922–931. [PubMed] [Google Scholar]
  6. Faulk D. L., Anuras S., Gardner G. D., Mitros F. A., Summers R. W., Christensen J. A familial visceral myopathy. Ann Intern Med. 1978 Nov;89(5 Pt 1):600–606. doi: 10.7326/0003-4819-89-5-600. [DOI] [PubMed] [Google Scholar]
  7. Lewis T. D., Daniel E. E., Sarna S. K., Waterfall W. E., Marzio L. Idiopathic intestinal pseudoobstruction. Report of a case, with intraluminal studies of mechanical and electrical activity, and response to drugs. Gastroenterology. 1978 Jan;74(1):107–111. [PubMed] [Google Scholar]
  8. Maldonado J. E., Gregg J. A., Green P. A., Brown A. L., Jr Chronic idiopathic intestinal pseudo-obstruction. Am J Med. 1970 Aug;49(2):203–212. doi: 10.1016/s0002-9343(70)80076-6. [DOI] [PubMed] [Google Scholar]
  9. Matzen P., Davidsen D., Mathiasen M. S. Megaduodenum. A case with bacterial overgrowth, deconjugation of bile salts, malabsorption, and polyneuropathy. Scand J Gastroenterol. 1974;9(7):645–650. [PubMed] [Google Scholar]
  10. McClelland H. A., Lewis M. J., Naish J. M. Idiopathic steatorrhoea with intestinal pseudo-obstruction. Gut. 1962 Jun;3(2):142–145. doi: 10.1136/gut.3.2.142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McCready R. A., Beart R. W., Jr The surgical treatment of incapacitating constipation associated with idiopathic megacolon. Mayo Clin Proc. 1979 Dec;54(12):779–783. [PubMed] [Google Scholar]
  12. Moss A. A., Goldberg H. I. Intestinal pseudo-obstruction. CRC Crit Rev Radiol Sci. 1972;3(3):363–387. [PubMed] [Google Scholar]
  13. Murley R. S. Painful Enteromegaly of Unknown AEtiology. Proc R Soc Med. 1959 Jun;52(6):479–480. [PMC free article] [PubMed] [Google Scholar]
  14. NAISH J. M., CAPPER W. M., BROWN N. J. Intestinal pseudoobstruction with steatorrhoea. Gut. 1960 Mar;1:62–66. doi: 10.1136/gut.1.1.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Nahai F. Pseudo-obstruction of the small bowel. Bristol Med Chir J. 1969 Oct;84(312):209–212. [PMC free article] [PubMed] [Google Scholar]
  16. Newton W. T. Radical enterectomy for hereditary megaduodenum. Arch Surg. 1968 Apr;96(4):549–553. doi: 10.1001/archsurg.1968.01330220065012. [DOI] [PubMed] [Google Scholar]
  17. PAUL C. A., TOMIYASU U., MELLINKOFF S. M. Nearly fatal pseudo-obstruction of the small intestine. A case report of its relief by subtotal resection of the small bowel. Gastroenterology. 1961 May;40:698–704. [PubMed] [Google Scholar]
  18. Sanna S. K., Daniel E. E., Waterfall W. E., Lewis T. D., Marzio L. Postoperative gastrointestinal electrical and mechanical activities in a patient with idiopathic intestinal pseudoobstruction. Gastroenterology. 1978 Jan;74(1):112–120. [PubMed] [Google Scholar]
  19. Schuffler M. D., Bird T. D., Sumi S. M., Cook A. A familial neuronal disease presenting as intestinal pseudoobstruction. Gastroenterology. 1978 Nov;75(5):889–898. [PubMed] [Google Scholar]
  20. Schuffler M. D., Lowe M. C., Bill A. H. Studies of idiopathic intestinal pseudoobstruction. I. Hereditary hollow visceral myopathy: clinical and pathological studies. Gastroenterology. 1977 Aug;73(2):327–338. [PubMed] [Google Scholar]
  21. Schuffler M. D., Pope C. E., 2nd Esophageal motor dysfunction in idiopathic intestinal pseudoobstruction. Gastroenterology. 1976 May;70(5 PT1):677–682. [PubMed] [Google Scholar]
  22. Schuffler M. D., Rohrmann C. A., Jr, Templeton F. E. The radiologic manifestations of idiopathic intestinal pseudoobstruction. AJR Am J Roentgenol. 1976 Nov;127(5):729–736. doi: 10.2214/ajr.127.5.729. [DOI] [PubMed] [Google Scholar]
  23. Sullivan M. A., Snape W. J., Jr, Matarazzo S. A., Petrokubi R. J., Jeffries G., Cohen S. Gastrointestinal myoelectrical activity in idiopathic intestinal pseudo-obstruction. N Engl J Med. 1977 Aug 4;297(5):233–238. doi: 10.1056/NEJM197708042970501. [DOI] [PubMed] [Google Scholar]
  24. UNCAPHER R. P., HOLDER H. G. Megaduodenum in the adult; report of a case. Am J Roentgenol Radium Ther Nucl Med. 1957 Apr;77(4):634–638. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES