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-obstructionIntestinal 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 does not contract and push food, stool, and air through the digestive tract. The chronic disorder most often affects the small intestine, but can also occur in the large intestine (colon). The acute disorder usually affects the large intestine.
The condition may start suddenly or be a chronic or long-term problem. Sudden onset is called acute intestinal pseudo-obstruction and usually affects the small intestine and often other parts of the digestive tract. Chronic intestinal pseudo-obstruction usually affects the large intestine (colon.) It is most common in children and older people. The cause of the problem is often unknown. However, problems with the bowel's muscles or nerves may be a cause.
Risk factors include:
- Cerebral palsy or other brain or nervous system disorders.
Cerebral palsy
Cerebral palsy (CP) is a group of disorders that involve the brain. This affects nervous system functions, such as movement, learning, hearing, seei...
Read Article Now Book Mark Article - Chronic kidney, lung, or heart disease.
- Staying in bed for long periods of time (bedridden).
- Taking medicines that slow intestinal movements. These include narcotic (pain) medicines and medicines used when you are not able to keep urine from leaking out.
- After surgery
Symptoms
Symptoms include:
- Abdominal pain
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
Read Article Now Book Mark Article - Bloating
- Constipation
- Nausea and vomiting
Nausea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
Read Article Now Book Mark Article - Swollen abdomen (abdominal distention)
Abdominal distention
A swollen abdomen is when your belly area is bigger than usual.
Read Article Now Book Mark Article - Weight loss
Weight loss
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...
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Exams and Tests
During a physical exam, the health care provider will most often see abdominal bloating.
Tests include:
- Abdominal x-ray
Abdominal x-ray
An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the liver, spleen, stomach, and intestines. Wh...
Read Article Now Book Mark Article - Anorectal manometry
- Barium swallow, barium small bowel follow-through, or barium enema
Barium swallow
An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine. Barium enema is a related test th...
Read Article Now Book Mark ArticleBarium enema
Barium enema is a special x-ray of the large intestine, which includes the colon and rectum.
Read Article Now Book Mark Article - Blood tests for nutritional or vitamin deficiencies
- Colonoscopy
Colonoscopy
A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope. The colonoscope has a sm...
Read Article Now Book Mark Article - CT scan of the abdomen
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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- Antroduodenal manometry
- Gastric emptying radionuclide scan
- Intestinal radionuclide scan
Treatment
The following treatments may be tried:
- Moving around (walking, changing position in bed)
- Colonoscopy may be used to remove air from the large intestine.
Colonoscopy
A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope. The colonoscope has a sm...
Read Article Now Book Mark Article - 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 or small intestine, or a tube through the rectum into the large intestine 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).
- Other medicines may be tried
- Special diets often do not work. However, vitamin B12 and other vitamin supplements should be used for people with vitamin deficiency.
- Correcting blood disturbances such as low potassium and others
- Rarely a tube to vent the intestine is placed in the first part of the large intestine (cecum)
- 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.
If the intestine dilates severely, a hole in the bowel (perforation) may occur and surgical removal of the involved bowel may be needed. This may result in an ostomy (attaching the bowel to the abdomen and stool passes into a bag. If malnutrition happens, you may need to be fed through a tube or the vein. Other parts of the GI tract may also have problems from poor contraction.
Possible Complications
Complications may include:
- Diarrhea
- Rupture (perforation) of the intestine
- Vitamin deficiencies
- Weight loss
When to Contact a Medical Professional
Contact your provider if you have abdominal pain that does not go away or other symptoms of this disorder.
References
Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 122.
Rayner CK, Hughes PA. Small intestinal motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 99.
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: 5/14/2024
Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.