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.
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
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:
- Abdominal pain
- Bloating
- Constipation
- Nausea and vomiting
- Swollen abdomen (abdominal distention)
- Weight loss
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:
- 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, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 127.
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.
Version Info
Last reviewed on: 5/4/2022
Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
