Pseudo Intestinal Occlusion: Case Report and Literature Review | Revista Médica del Hospital General de México

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Mean of coordinates (±SD) in mm were for right side (x=20.5±1.5, y=1.9±1.7, z=-3.5±0.5) for left side (x=19.7±1.1, y=2.6±1.8, z=-3.3±0.6). Arrows show location of leads in Gpi." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Meneses-Rodríguez, Ricardo Y. Sánchez, Humberto Carrasco-Vargas, Abenamar Samano-Osuna, Fiacro Jiménez-Ponce" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Meneses-Rodríguez" ] 1 => array:2 [ "nombre" => "Ricardo Y." 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Gutiérrez-Uvalle" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Mariel" "apellidos" => "González-Calatayud" "email" => array:1 [ 0 => "md_mariel@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Gabriela E." "apellidos" => "Gutiérrez-Uvalle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Médico Adscrito al servicio de Urgencias, Hospital General de México “Dr. Eduardo Liceaga”, México D. F." "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Jefe de la Unidad Quirúrgica del servicio de Urgencias, Hospital General de México “Dr. Eduardo Liceaga”, México D. F." "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author. Hospital General de México, “Dr. Eduardo Liceaga”, Servicio de Urgencias Unidad 401C. Dr. Balmis No. 148, Col. Doctores, C. P. 06720, Del. Cuauhtémoc. México D. F. México." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudo-Obstrucción Intestinal: Presentación de un Caso y Revisión de la Literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 668 "Ancho" => 995 "Tamanyo" => 143750 ] ] "descripcion" => array:1 [ "en" => "Evidence of trans-operative distension of the colon with cecum of 18cm in diameter. Small intestine normal." ] ] ] "textoCompleto" => "IntroductionChronic intestinal pseudo-obstruction (CIPO) is a rare and severe disease characterized by the failure of the small bowel or colon to propel the contents of the intestinal tract simulating mechanical occlusion<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a>. It is one of the most important causes of chronic intestinal failure affecting both pediatric population (15%) and adults (20%). The ultimate result is an important nutritional deficiency. Often overlooked or misdiagnosed until complications or clinical symptoms<a class="elsevierStyleCrossRef" href="#bib0005">1</a> appeared. Constipation on the other hand, is one of the most common diseases with an incidence of 5-20%<a class="elsevierStyleCrossRef" href="#bib0020">4</a>.Case ReportA 75 years old male who was admitted to our hospital due to abdominal pain and distention. It started five days before admission, with colic generalized abdominal pain, after food ingestion, intensity 4 out of 10, with partial improvement with Acetaminophen. Associate with anorexia, constipation and progressive obstipation. One day prior to admission, the patient refers fatigue, weakness and nausea without vomiting. He was treated with enemas and antibiotics without changes, so he decided to attend to our hospital. On admission, physical examination highlights tachycardia, dehydration, major abdominal distention, absence of bowel sounds, pain on superficial and deep palpation, negative sign of peritoneal irritation, generalized bloating, consistent with bowel obstruction. Laboratory findings highlight pre-renal failure, hyperglycemia, hypokalemia, hypocalcemia and metabolic acidosis. Blood count and liver function tests were within normal parameters. The patient has a 10 year history of Parkinson's disease treated with amantadine 100mg every 8hours, levodopa / carbidopa 250mg / 25mg every 8hours. Also, Diabetes Mellitus treated with metformin and systemic hypertension in treatment with felodipine 5mg every 12hours. Surgical history of transurethral prostatic resection 10 years ago.The initial treatment was electrolyte management, nasogastric decompression, Foley and central venous catheter. Plain abdominal radiographs in two positions showed distended colon, with a cecum over 14cm in diameter, and a redundant transverse colon and sigmoid (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1 and 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>We decided to perform an exploratory laparotomy and it was found a fully dilated colon, cecum 18cm in diameter, transverse colon 12cm in diameter, descending and sigmoid colon 15cm in diameter; without macroscopic evidence of mechanical obstruction anywhere (<a class="elsevierStyleCrossRefs" href="#fig0010">Image 3 and 4</a>). The small intestine macroscopically normal. We perform a total colectomy, closure of the rectum with Hartmann's procedure and ileostomy. The posoperative outcome of the patient was favorable, tolerated oral diet 12hrs after surgery, and a functional ileostomy 24hrs after surgery. His family requested to take home the patient 48hrs postoperatively for economic reasons, however, stable. Phone monitoring is done a week of discharge, referring asymptomatic, functional ileostomy with approximately 500cc a day.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The pathology reports a specimen macroscopically of 222x14x14cm with congestive surface, ileum 8cm long and appendix of 9x0.6x0.6cm; flattened mucosa, light brown and slightly congestive (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 5</a>). In histological sections of the muscularis, they observed present ganglion cells without dysplasia. The histopathological diagnosis reports mild nonspecific colitis consistent with chronic idiopathic intestinal pseudo-obstruction and acute peritonitis.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionThe main causes of intestinal pseudo-obstruction can be divided into: 1) idiopathic (Ogilvie syndrome), 2) both enteric disease or central autonomic nervous system (stroke, encephalitis, basal ganglia calcification, orthostatic hypotension, Von Recklinghausen disease, Hirshsprung disease), 3) collagen diseases (paraneoplasic, scleroderma, dermatomyositis, amyloidosis, Ehlers-Danlos syndrome, lupus, among others), 4) endocrine and metabolic diseases (diabetes mellitus, hypothyroidism, hyperparathyroidism, pheochromocytoma), 5) drugs (clonidine phenothiazines, antidepressants, antiparkinsonian, antineoplastic, bronchodilators, anthraquinone), and 6) other (iatrogenic, yeyunal diverticula and Chagas disease) (1,3). The autonomic etiology is the most comun patology, specifically in the colon<a class="elsevierStyleCrossRefs" href="#bib0020">4,6</a>.The typical clinical features are recurrent episodes of abdominal pain, bloating, constipation and obstipation, with or without nausea, vomiting, dysphagia and weight loss<a class="elsevierStyleCrossRefs" href="#bib0005">1,3,5</a>. Only 25% of patients presents an acute episode, where radiographical findings are dilated bowel loops and air-fluid levels. Entero-CT can be done to rule out mechanical occlusion<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>. The natural course of the disease is usually progressive deterioration and chronically malnutrition. The most frequent causes of death are related to the parenteral nutrition, transplant or post-surgical complications due to septic shock which is observed in 50% pf patients 5 years from treatment<a class="elsevierStyleCrossRef" href="#bib0005">1</a>.The initial treatment during the acute episode is intravenous fluids and electrolytes, abdominal decompression with a nasogastric or rectal tube, colonoscopy or cecostomy; tegaserod, cisapride, erythromycin, somatostatin or octreotide and / or neostigmine (1.5). The pucalopride can also improve the chronic state (6).The diagnosis is made with full thickness biopsies. Surgery is considered when signs of multiple organ failure appeared, important abdominal distension or failure of medical treatment, which occurs in 58% of patients<a class="elsevierStyleCrossRefs" href="#bib0005">1,2,7</a>. Indications of medical treatment failure are younger age, chronic disease, bloating as the main symptom and major cecum distention<a class="elsevierStyleCrossRef" href="#bib0010">2</a>.Current Surgical treatment for megacolon<a class="elsevierStyleCrossRef" href="#bib0035">7</a>:Colon Procedures:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Subtotal colectomy: 71% therapeutic success (75% ileo-sigmoid anastomoses, 77% ileo-rectal anastomoses, 50% ceco-rectal anastomoses). Mortality up to 14%,complication rate of 25% secondary to anastomotic complications, recurrent intestinal obstruction (14.5%), and fecal incontinence (20%).</li><li class="elsevierStyleListItem" id="lsti0010">•Segmental colectomy: 48.4% therapeutic success, mortality and morbidity of 2.3% to 13% with reoperation rate of 23.8%.</li></ul>Rectal Procedures:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015">•Anterior rectal resection: there is only one study reporting a success of 75% with a 50% of complication rate.</li><li class="elsevierStyleListItem" id="lsti0020">•Proctectomy: treatment success of 71%, mortality 6.5%, morbidity 6.5% and 9.7% reoperation for recurrent constipation (14-17%).</li><li class="elsevierStyleListItem" id="lsti0025">•endorectal pull-through: only one study was performed in 4 patients with 25% mortality, 75% morbidity, reoperation 50% pelvic abscess.</li><li class="elsevierStyleListItem" id="lsti0030">•Duhamel procedure: therapeutic success. 87%, 3% mortality, 60% morbidity (rectovaginal fistula or bowel, pelvic abscess, anastomotic stricture), recurrent constipation 7%.</li><li class="elsevierStyleListItem" id="lsti0035">•Vertical rectoplastia: new procedure, only one study reported in the therapeutic success of 83%, 17% morbidity (fistula) and no mortality.</li><li class="elsevierStyleListItem" id="lsti0040">•Restorative proctocolectomy: 73% treatment success, mortality 0%, 0-40% morbidity (anastomotic leakage, nocturnal fecal incontinence).</li></ul>Pelvic Floor Procedure:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045">•Internal Sphincterotomy: as beneficial in 33% and 40% secondary procedure when it is primary.</li><li class="elsevierStyleListItem" id="lsti0050">•Division puborectalis: No evidence of being a functional procedure for this condition.</li></ul>Stoma: 40-100% treatment success, mortality 0%, morbidity 17%.CB Ó Súilleabháin<a class="elsevierStyleCrossRef" href="#bib0040">8</a> proposes the following treatment scheme megacolon (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 6</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Eon Han Chul<a class="elsevierStyleCrossRef" href="#bib0020">4</a> in a study of 33 patients with colonic pseudo-obstruction, postoperative complications reported in 22% of patients with the most frequent surgical wound infection, followed by ileus, intra-abdominal abscess and diarrhea.ConclusionIn the case of our patient, presented clinical data of no mechanical bowel obstruction that may be idiopathic or secondary to drugs, especially anti-Parkinson. He presented a favorable postoperative evolution with possible intestinal reconnection in 3-6 months. We decided not to perform the anastomosis in the same surgical procedure by not having an accurate diagnosis and information about the absence of ganglion cells or commitment anorectal complex, however, based on the good performance, we propose the combination of colectomy with ileostomy in patients managed as a surgical emergency, although further studies are requiered to determine the usefulness of this therapeutic approach." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres414103" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Case Report" 3 => "Discussion" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec389757" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres414102" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Caso clínico" 3 => "Discusión" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec389756" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-07-23" "fechaAceptado" => "2014-09-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec389757" "palabras" => array:4 [ 0 => "Pseudo-intestinal occlusion" 1 => "Ogilvie syndrome" 2 => "megacolon" 3 => "magarectum" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec389756" "palabras" => array:4 [ 0 => "Pseudo-obstrucción intestinal" 1 => "síndrome de Ogilvie" 2 => "megacolon" 3 => "magarecto" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionChronic intestinal pseudo-obstruction is a rare but severe disease. Often passes unrecognized for long time. Case Report75-year-old Hispanic male with a history of Parkinson ¿s disease, Diabetes Mellitus Type 2 and Chronic Arterial Hypertension. He came to the ER with a 5 day progressive evolution of abdominal pain, distension, hyporexia and obstipation. A laparotomy was performed where we found a distended colon. We proceeded with a total colectomy and ileostomy. The specimen was 222x14x14cm with a thin muscularis propria and present lymphatic cells. Post-operative course was unremarkable. The patient was sent home 48hr after the surgery tolerating soft diet. DiscussionThe main causes are idiopathic, diseases of central autonomic and enteric nervous systems, immune, collagen and metabolic diseases. Surgery is intended when there is multiple organ failure, important distention or failure of the medical treatment. ConclusionThis case report highlights the importance of differential diagnosis and treatment of non-mechanical intestinal obstruction secondary to the effects of anti-parkinsonians, metabolic or idiopathic nature. With good surgical technique a positive outcome is likely." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa pseudo-obstrucción intestinal crónica es una enfermedad rara y severa. Muchas veces pasa desapercibido o tratado con diagnósticos incorrectos. Caso clínicoMasculino de 75 años con antecedentes de Parkinson, Diabetes Mellitus tipo 2 e Hipertensión Arterial Sistémica. Inicia 5 días previos con dolor abdominal, hiporexia, constipación, obstipación, astenia, adinamia y nausea. Presenta distensión abdominal, aperistalsis, dolor y timpanismo. En las radiografías muestra distensión de colon generalizado. Se decide realizar Laparotomía Exploradora encontrando colon dilatado en su totalidad, sin obstrucción mecánica. Se realiza colectomía total e ileostomía. El paciente evoluciona de forma favorable sin complicaciones. El resultado histopatológico: espécimen de 222x14x14cm con adelgazamiento de la muscular propia y células ganglionares presentes. DiscusiónLas principales causas son idiopático, enfermedad del sistema nervioso autonómico, enfermedades de la colágena o metabólicas. El cuadro clínico son episodios recurrentes de dolor abdominal, distensión, constipación y obstipación. Se considera la cirugía cuando existe falla orgánica múltiple, distensión importante o falla del tratamiento médico. ConclusiónEste caso debuta con un cuadro obstrucción intestinal no mecánica que pudiera ser de origen idiopático, secundaria a fármacos o metabólico. 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Clinical case

Pseudo Intestinal Occlusion: Case Report and Literature Review

Pseudo-Obstrucción Intestinal: Presentación de un Caso y Revisión de la Literatura

Mariel González-Calatayuda,

Corresponding author

md_mariel@yahoo.com

Corresponding author. Hospital General de México, “Dr. Eduardo Liceaga”, Servicio de Urgencias Unidad 401C. Dr. Balmis No. 148, Col. Doctores, C. P. 06720, Del. Cuauhtémoc. México D. F. México.

, Gabriela E. Gutiérrez-Uvalleb

a Médico Adscrito al servicio de Urgencias, Hospital General de México “Dr. Eduardo Liceaga”, México D. F.

b Jefe de la Unidad Quirúrgica del servicio de Urgencias, Hospital General de México “Dr. Eduardo Liceaga”, México D. F.

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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evidence of trans-operative distension of the colon with cecum of 18<span class="elsevierStyleHsp" style=""></span>cm in diameter. Small intestine normal.</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic intestinal pseudo-obstruction (CIPO) is a rare and severe disease characterized by the failure of the small bowel or colon to propel the contents of the intestinal tract simulating mechanical occlusion<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>. It is one of the most important causes of chronic intestinal failure affecting both pediatric population (15%) and adults (20%). The ultimate result is an important nutritional deficiency. Often overlooked or misdiagnosed until complications or clinical symptoms<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> appeared. Constipation on the other hand, is one of the most common diseases with an incidence of 5-20%<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Case Report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 75 years old male who was admitted to our hospital due to abdominal pain and distention. It started five days before admission, with colic generalized abdominal pain, after food ingestion, intensity 4 out of 10, with partial improvement with Acetaminophen. Associate with anorexia, constipation and progressive obstipation. One day prior to admission, the patient refers fatigue, weakness and nausea without vomiting. He was treated with enemas and antibiotics without changes, so he decided to attend to our hospital. On admission, physical examination highlights tachycardia, dehydration, major abdominal distention, absence of bowel sounds, pain on superficial and deep palpation, negative sign of peritoneal irritation, generalized bloating, consistent with bowel obstruction. Laboratory findings highlight pre-renal failure, hyperglycemia, hypokalemia, hypocalcemia and metabolic acidosis. Blood count and liver function tests were within normal parameters. The patient has a 10 year history of Parkinson&#39;s disease treated with amantadine 100<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>hours, levodopa / carbidopa 250<span class="elsevierStyleHsp" style=""></span>mg / 25<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>hours. Also, Diabetes Mellitus treated with metformin and systemic hypertension in treatment with felodipine 5<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>hours. Surgical history of transurethral prostatic resection 10 years ago.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The initial treatment was electrolyte management, nasogastric decompression, Foley and central venous catheter. Plain abdominal radiographs in two positions showed distended colon, with a cecum over 14<span class="elsevierStyleHsp" style=""></span>cm in diameter, and a redundant transverse colon and sigmoid (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We decided to perform an exploratory laparotomy and it was found a fully dilated colon, cecum 18<span class="elsevierStyleHsp" style=""></span>cm in diameter, transverse colon 12<span class="elsevierStyleHsp" style=""></span>cm in diameter, descending and sigmoid colon 15<span class="elsevierStyleHsp" style=""></span>cm in diameter; without macroscopic evidence of mechanical obstruction anywhere (<a class="elsevierStyleCrossRefs" href="#fig0010">Image 3 and 4</a>). The small intestine macroscopically normal. We perform a total colectomy, closure of the rectum with Hartmann&#39;s procedure and ileostomy. The posoperative outcome of the patient was favorable, tolerated oral diet 12<span class="elsevierStyleHsp" style=""></span>hrs after surgery, and a functional ileostomy 24<span class="elsevierStyleHsp" style=""></span>hrs after surgery. His family requested to take home the patient 48<span class="elsevierStyleHsp" style=""></span>hrs postoperatively for economic reasons, however, stable. Phone monitoring is done a week of discharge, referring asymptomatic, functional ileostomy with approximately 500cc a day.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The pathology reports a specimen macroscopically of 222x14x14<span class="elsevierStyleHsp" style=""></span>cm with congestive surface, ileum 8<span class="elsevierStyleHsp" style=""></span>cm long and appendix of 9x0.6x0.6<span class="elsevierStyleHsp" style=""></span>cm; flattened mucosa, light brown and slightly congestive (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 5</a>). In histological sections of the muscularis, they observed present ganglion cells without dysplasia. The histopathological diagnosis reports mild nonspecific colitis consistent with chronic idiopathic intestinal pseudo-obstruction and acute peritonitis.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The main causes of intestinal pseudo-obstruction can be divided into: 1) idiopathic (Ogilvie syndrome), 2) both enteric disease or central autonomic nervous system (stroke, encephalitis, basal ganglia calcification, orthostatic hypotension, Von Recklinghausen disease, Hirshsprung disease), 3) collagen diseases (paraneoplasic, scleroderma, dermatomyositis, amyloidosis, Ehlers-Danlos syndrome, lupus, among others), 4) endocrine and metabolic diseases (diabetes mellitus, hypothyroidism, hyperparathyroidism, pheochromocytoma), 5) drugs (clonidine phenothiazines, antidepressants, antiparkinsonian, antineoplastic, bronchodilators, anthraquinone), and 6) other (iatrogenic, yeyunal diverticula and Chagas disease) (1,3). The autonomic etiology is the most comun patology, specifically in the colon<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The typical clinical features are recurrent episodes of abdominal pain, bloating, constipation and obstipation, with or without nausea, vomiting, dysphagia and weight loss<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5</span></a>. Only 25% of patients presents an acute episode, where radiographical findings are dilated bowel loops and air-fluid levels. Entero-CT can be done to rule out mechanical occlusion<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. The natural course of the disease is usually progressive deterioration and chronically malnutrition. The most frequent causes of death are related to the parenteral nutrition, transplant or post-surgical complications due to septic shock which is observed in 50% pf patients 5 years from treatment<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The initial treatment during the acute episode is intravenous fluids and electrolytes, abdominal decompression with a nasogastric or rectal tube, colonoscopy or cecostomy; tegaserod, cisapride, erythromycin, somatostatin or octreotide and / or neostigmine (1.5). The pucalopride can also improve the chronic state (6).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis is made with full thickness biopsies. Surgery is considered when signs of multiple organ failure appeared, important abdominal distension or failure of medical treatment, which occurs in 58% of patients<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,7</span></a>. Indications of medical treatment failure are younger age, chronic disease, bloating as the main symptom and major cecum distention<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Current Surgical treatment for megacolon<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>:</p><p id="par0055" class="elsevierStylePara elsevierViewall">Colon Procedures:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Subtotal colectomy: 71% therapeutic success (75% ileo-sigmoid anastomoses, 77% ileo-rectal anastomoses, 50% ceco-rectal anastomoses). Mortality up to 14%,complication rate of 25% secondary to anastomotic complications, recurrent intestinal obstruction (14.5%), and fecal incontinence (20%).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Segmental colectomy: 48.4% therapeutic success, mortality and morbidity of 2.3% to 13% with reoperation rate of 23.8%.</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Rectal Procedures:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Anterior rectal resection: there is only one study reporting a success of 75% with a 50% of complication rate.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Proctectomy: treatment success of 71%, mortality 6.5%, morbidity 6.5% and 9.7% reoperation for recurrent constipation (14-17%).</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">endorectal pull-through: only one study was performed in 4 patients with 25% mortality, 75% morbidity, reoperation 50% pelvic abscess.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Duhamel procedure: therapeutic success. 87%, 3% mortality, 60% morbidity (rectovaginal fistula or bowel, pelvic abscess, anastomotic stricture), recurrent constipation 7%.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Vertical rectoplastia: new procedure, only one study reported in the therapeutic success of 83%, 17% morbidity (fistula) and no mortality.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Restorative proctocolectomy: 73% treatment success, mortality 0%, 0-40% morbidity (anastomotic leakage, nocturnal fecal incontinence).</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">Pelvic Floor Procedure:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Internal Sphincterotomy: as beneficial in 33% and 40% secondary procedure when it is primary.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Division puborectalis: No evidence of being a functional procedure for this condition.</p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall">Stoma: 40-100% treatment success, mortality 0%, morbidity 17%.</p><p id="par0125" class="elsevierStylePara elsevierViewall">CB &Oacute; S&uacute;illeabh&aacute;in<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> proposes the following treatment scheme megacolon (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 6</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Eon Han Chul<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in a study of 33 patients with colonic pseudo-obstruction, postoperative complications reported in 22% of patients with the most frequent surgical wound infection, followed by ileus, intra-abdominal abscess and diarrhea.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">In the case of our patient, presented clinical data of no mechanical bowel obstruction that may be idiopathic or secondary to drugs, especially anti-Parkinson. He presented a favorable postoperative evolution with possible intestinal reconnection in 3-6 months. We decided not to perform the anastomosis in the same surgical procedure by not having an accurate diagnosis and information about the absence of ganglion cells or commitment anorectal complex, however, based on the good performance, we propose the combination of colectomy with ileostomy in patients managed as a surgical emergency, although further studies are requiered to determine the usefulness of this therapeutic approach.</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic intestinal pseudo-obstruction is a rare but severe disease. Often passes unrecognized for long time.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Case Report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">75-year-old Hispanic male with a history of Parkinson ¿s disease, Diabetes Mellitus Type 2 and Chronic Arterial Hypertension. He came to the ER with a 5 day progressive evolution of abdominal pain, distension, hyporexia and obstipation. A laparotomy was performed where we found a distended colon. We proceeded with a total colectomy and ileostomy. The specimen was 222x14x14<span class="elsevierStyleHsp" style=""></span>cm with a thin muscularis propria and present lymphatic cells. Post-operative course was unremarkable. The patient was sent home 48hr after the surgery tolerating soft diet.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The main causes are idiopathic, diseases of central autonomic and enteric nervous systems, immune, collagen and metabolic diseases. Surgery is intended when there is multiple organ failure, important distention or failure of the medical treatment.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This case report highlights the importance of differential diagnosis and treatment of non-mechanical intestinal obstruction secondary to the effects of anti-parkinsonians, metabolic or idiopathic nature. With good surgical technique a positive outcome is likely.</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&oacute;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La pseudo-obstrucci&oacute;n intestinal cr&oacute;nica es una enfermedad rara y severa. Muchas veces pasa desapercibido o tratado con diagn&oacute;sticos incorrectos.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Caso cl&iacute;nico</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Masculino de 75 a&ntilde;os con antecedentes de Parkinson, Diabetes Mellitus tipo 2 e Hipertensi&oacute;n Arterial Sist&eacute;mica. Inicia 5 d&iacute;as previos con dolor abdominal, hiporexia, constipaci&oacute;n, obstipaci&oacute;n, astenia, adinamia y nausea. Presenta distensi&oacute;n abdominal, aperistalsis, dolor y timpanismo. En las radiograf&iacute;as muestra distensi&oacute;n de colon generalizado. Se decide realizar Laparotom&iacute;a Exploradora encontrando colon dilatado en su totalidad, sin obstrucci&oacute;n mec&aacute;nica. Se realiza colectom&iacute;a total e ileostom&iacute;a. El paciente evoluciona de forma favorable sin complicaciones. El resultado histopatol&oacute;gico: esp&eacute;cimen de 222x14x14<span class="elsevierStyleHsp" style=""></span>cm con adelgazamiento de la muscular propia y c&eacute;lulas ganglionares presentes.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Discusi&oacute;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las principales causas son idiop&aacute;tico, enfermedad del sistema nervioso auton&oacute;mico, enfermedades de la col&aacute;gena o metab&oacute;licas. El cuadro cl&iacute;nico son episodios recurrentes de dolor abdominal, distensi&oacute;n, constipaci&oacute;n y obstipaci&oacute;n. Se considera la cirug&iacute;a cuando existe falla org&aacute;nica m&uacute;ltiple, distensi&oacute;n importante o falla del tratamiento m&eacute;dico.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&oacute;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este caso debuta con un cuadro obstrucci&oacute;n intestinal no mec&aacute;nica que pudiera ser de origen idiop&aacute;tico, secundaria a f&aacute;rmacos o metab&oacute;lico. La colectom&iacute;a con ileostom&iacute;a es una alternativa quir&uacute;rgica aceptable y segura.</p>"
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                            0 => "Kwang Jae Lee"
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                      "titulo" => "Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study"
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                            0 => "Vincenzo Stanghellini"
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Article information

ISSN: 01851063
Original language: English

DOI:10.1016/j.hgmx.2014.11.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	6	11
2024 October	52	7	59
2024 September	64	10	74
2024 August	49	8	57
2024 July	55	10	65
2024 June	55	2	57
2024 May	64	9	73
2024 April	57	9	66
2024 March	53	21	74
2024 February	76	11	87
2024 January	88	15	103
2023 December	92	12	104
2023 November	96	4	100
2023 October	121	13	134
2023 September	62	5	67
2023 August	69	6	75
2023 July	77	17	94
2023 June	104	6	110
2023 May	149	13	162
2023 April	99	5	104
2023 March	91	7	98
2023 February	89	12	101
2023 January	103	12	115
2022 December	103	6	109
2022 November	105	11	116
2022 October	64	29	93
2022 September	71	15	86
2022 August	58	10	68
2022 July	63	7	70
2022 June	63	13	76
2022 May	72	9	81
2022 April	70	23	93
2022 March	62	11	73
2022 February	59	15	74
2022 January	101	9	110
2021 December	68	17	85
2021 November	62	8	70
2021 October	57	16	73
2021 September	59	16	75
2021 August	87	9	96
2021 July	42	8	50
2021 June	48	10	58
2021 May	54	7	61
2021 April	221	23	244
2021 March	283	18	301
2021 February	102	7	109
2021 January	102	13	115
2020 December	74	9	83
2020 November	56	6	62
2020 October	31	8	39
2020 September	27	7	34
2020 August	70	8	78
2020 July	42	10	52
2020 June	43	2	45
2020 May	64	5	69
2020 April	60	2	62
2020 March	67	4	71
2020 February	66	5	71
2020 January	59	6	65
2019 December	67	8	75
2019 November	80	8	88
2019 October	51	5	56
2019 September	69	8	77
2019 August	45	2	47
2019 July	71	16	87
2019 June	117	23	140
2019 May	230	56	286
2019 April	138	25	163
2019 March	46	8	54
2019 February	42	5	47
2019 January	29	9	38
2018 December	44	3	47
2018 November	49	9	58
2018 October	87	5	92
2018 September	75	13	88
2018 August	49	10	59
2018 July	46	8	54
2018 June	50	10	60
2018 May	63	7	70
2018 April	33	6	39
2018 March	52	7	59
2018 February	41	4	45
2018 January	40	6	46
2017 December	34	3	37
2017 November	37	8	45
2017 October	53	6	59
2017 September	26	7	33
2017 August	30	12	42
2017 July	35	8	43
2017 June	59	10	69
2017 May	94	6	100
2017 April	42	13	55
2017 March	61	87	148
2017 February	106	10	116
2017 January	51	9	60
2016 December	76	9	85
2016 November	76	22	98
2016 October	111	18	129
2016 September	141	13	154
2016 August	71	14	85
2016 July	122	2	124
2016 June	123	29	152
2016 May	121	25	146
2016 April	125	29	154
2016 March	153	33	186
2016 February	148	22	170
2016 January	94	34	128
2015 December	149	21	170
2015 November	87	19	106
2015 October	90	32	122
2015 September	107	24	131
2015 August	146	25	171
2015 July	143	22	165
2015 June	92	14	106
2015 May	107	38	145
2015 April	107	47	154
2015 March	146	44	190
2015 February	78	15	93
2015 January	73	35	108
2014 December	8	4	12

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