Pseudo-obstruction is a clinical syndrome caused by ineffective intestinal propulsion and characterized by symptoms and signs of intestinal obstruction in the absence of an occluding lesion of the intestinal lumen. A 65-year-old male who complained of abdominal pain and obspitation. (not constipation?) was admitted. Simple abdominal radiographs revealed marked colonic dilatation without mechanical obstruction suggesting pseudo-obstruction. Clinical response with conservative care failed to improve the patient. 2.0 mg of neostigmine which was recently reported to be an effective way to decompress the colon in patients with acute colonic pseudo-obstruction, was administered. Immediate clinical response was achieved without complication.
Abdominal Pain ; Aged ; Colon ; Colonic Pseudo-Obstruction ; Dilatation ; Humans ; Intestinal Obstruction ; Intestinal Pseudo-Obstruction ; Male ; Neostigmine*

Pseudo-obstruction is a clinical syndrome caused by ineffective intestinal propulsion and characterized by symptoms and signs of intestinal obstruction in the absence of an occluding lesion of the intestinal lumen. A 65-year-old male who complained of abdominal pain and obspitation. (not constipation?) was admitted. Simple abdominal radiographs revealed marked colonic dilatation without mechanical obstruction suggesting pseudo-obstruction. Clinical response with conservative care failed to improve the patient. 2.0 mg of neostigmine which was recently reported to be an effective way to decompress the colon in patients with acute colonic pseudo-obstruction, was administered. Immediate clinical response was achieved without complication.
Abdominal Pain ; Aged ; Colon ; Colonic Pseudo-Obstruction ; Dilatation ; Humans ; Intestinal Obstruction ; Intestinal Pseudo-Obstruction ; Male ; Neostigmine*

A chronic intestinal pseudo-obstruction is a rare disorder and a severe digestive syndrome. It is characterized by deranged gut propulsive motility that resembles a mechanical obstruction, but no obstructive process is present. An intestinal pseudo-obstruction may be classified as acute or chronic; the chronic form may also be classified as idiopathic or secondary to a variety of diseases. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological, and surgical therapies. Surgery should be limited to patients who are refractory to medical therapy and show a deteriorating course. Despite available medical and surgical interventions, the outcome remains poor. Here, we describe a case of a 54-year-old female with chronic constipation and abdominal distension, who was subsequently found to have segmental aganglionosis. The patient was treated with a subtotal colectomy and ileosigmoidostomy without sequelae.
Adult ; Colectomy ; Colonic Pseudo-Obstruction ; Constipation ; Female ; Fluconazole ; Hirschsprung Disease ; Humans ; Intestinal Pseudo-Obstruction ; Middle Aged

Acute colonic pseudoobstruction was first reported in 1948 by Sir H. Ogilvie. It is characterized by an acute, abrupt right-sided colonic distention in the absence of physical reasons for obstruction. If untreated, it may progress to cecal perforation, peritonitis, and death. Although primary cases have been reported, 87 percent of cases were secondary results of medical or surgical conditions. The most common medical conditions were infections, cardiac disease, and neurologic problems. In surgical conditions, cesarean section has been reported as the most common cause of Ogilvie's syndrome. In 1995, the first case of Ogilvie's syndrome complicated after a cosmetic surgical procedure(abdominoplasty) was reported by Bradley et al. We report a case of Ogilvie's syndrome complicated after breast reconstruction with TRAM flap that developed in the postoperative third day in 35-year old woman. The complications are primarily related to decreased flap perfusion. No reference of intestinal pseudoobstruction was found in the literature conducted in regard to complications of TRAM flap breast reconstruction.
Adult ; Breast* ; Cesarean Section ; Colon ; Colonic Pseudo-Obstruction ; Female ; Heart Diseases ; Humans ; Intestinal Pseudo-Obstruction ; Mammaplasty* ; Perfusion ; Peritonitis ; Pregnancy

Pseudo-obstruction of the colon, first described by Ogilvie1 in 1948 and usually referred to as Ogilvie's syndrome, is a specific variety of adynamic ileus. It is characterized by massive colonic dilatation with a clinical and radiologic findings very similar to mechanical large intestinal obstruction, except that there is no organic obstruction. The cecum is usually the site of greatest dilatation, though the whole large bowel may be involved, from the terminal ileum up to the rectosigmoid junction. The dilatation is rapidly progressive and, if untreated, may even cause cecal necrosis and perforation, with highly increased mortality rate. The syndrome has been associated with various metabolic and organic dysfunctions, and has been observed following gynecologic as well as simple surgical procedures; yet its occurrence has been rather uncommon. The followings are two case reports with this syndrome.
Cecum ; Colon* ; Colonic Pseudo-Obstruction* ; Dilatation ; Ileum ; Ileus ; Intestinal Obstruction ; Mortality ; Necrosis

Chronic colonic pseudo-obstruction is a rare disease that results in colorectal dilatation without any obstructing lesions. Colonic dilatation does not usually cause colonic wall thickening and colonic visceral myopathy with muscular hypertrophy has not been reported in Korea. A 31-year-old female patient was transferred for treatment of refractory constipation accompanied by megacolon. She had suffered from recurrent attacks of severe abdominal pain with the sensation of a mass in the left lower quadrant. An abdominal CT revealed a large luminal dilatation of the sigmoid colon where massive stool was impacted. There was no obstructing lesion or luminal dilatation of the rectum. To relieve her refractory symptoms, a total colectomy with an ileorectal anastomosis was performed. Pathologic examination of the sigmoid colon revealed that the muscle layers were dysplastic and hypertrophied, and the innervations into the muscle fibers were markedly decreased. She was discharged without any intra-abdominal symptoms.
Abdominal Pain ; Adult ; Colectomy ; Colon ; Colon, Sigmoid ; Colonic Pseudo-Obstruction ; Constipation ; Dilatation ; Female ; Humans ; Hypertrophy ; Intestinal Pseudo-Obstruction ; Korea ; Megacolon ; Muscles ; Phenobarbital ; Rare Diseases ; Rectum ; Sensation

Chronic intestinal pseudo-obstruction is characterized by severe alteration to the intestinal motility, with clinical features that mimic those of a mechanical obstruction in the absence of any organic obstacle to the intestinal transit. The syndrome is induced by a disease of the muscle layer or intrinsic nerves. However, the sporadic degenerative non-inflammatory type of visceral neuropathy is rare. A 65-year-old woman was admitted to our institution due to chronic constipation and abdominal distention. She had a past history of admission due to repeated chronic constipation. An abdomen-pelvic CT revealed no evidence of an organic cause of the obstruction. Her colonic transit time was delayed. An anorectal manometry showed a normal rectoanal inhibitory reflex, but a decreased maximal pressure. A colon study revealed a pseudo-obstruction at the splenic flexure level. Her symptoms were not improved with conservative management; therefore, a subtotal colectomy was subsequently performed. The pathological diagnosis was that of sporadic degenerative non-inflammatory visceral neuropathy. The patient recovered uneventfully, and showed normal bowel movement during the follow-up period.
Aged ; Colectomy ; Colon* ; Colon, Transverse ; Colonic Pseudo-Obstruction* ; Constipation ; Diagnosis ; Female ; Follow-Up Studies ; Gastrointestinal Motility ; Humans ; Intestinal Pseudo-Obstruction ; Manometry ; Reflex

BACKGROUND/AIMS: Previous studies from Korea have described chronic intestinal pseudo-obstruction (CIPO) patients with transition zone (TZ) in the colon. In this study, we evaluated the pathological characteristics and their association with long-term outcomes in Korean colonic pseudo-obstruction (CPO) patients with TZ. METHODS: We enrolled 39 CPO patients who were refractory to medical treatment and underwent colectomy between November 1989 and April 2016 (median age at symptoms onset: 45 [interquartile range, 29–57] years, males 46.2%). The TZ was defined as a colonic segment connecting a proximally dilated and distally non-dilated segment. Detailed pathologic analysis was performed. RESULTS: Among the 39 patients, 37 (94.9%) presented with TZ and 2 (5.1%) showed no definitive TZ. Median ganglion cell density in the TZ adjusted for the colonic circumference was significantly decreased compared to that in proximal dilated and distal non-dilated segments in TZ (+) patients (9.2 vs 254.3 and 150.5, P < 0.001). Among the TZ (+) patients, 6 showed additional pathologic findings including eosinophilic ganglionitis (n = 2), ulcers with combined cytomegalovirus infection (n = 2), diffuse ischemic changes (n = 1), and heterotropic myenteric plexus (n = 1). During follow-up (median, 61 months), 32 (82.1%) TZ (+) patients recovered without symptom recurrence after surgery. The presence of pathological features other than hypoganglionosis was an independent predictor of symptom recurrence after surgery (P = 0.046). CONCLUSIONS: Hypoganglionosis can be identified in the TZ of most Korean CPO patients. Detection of other pathological features in addition to TZ-associated hypoganglionosis was associated with poor post-operative outcomes.
Cell Count ; Colectomy ; Colon ; Colonic Pseudo-Obstruction ; Cytomegalovirus Infections ; Eosinophils ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Intestinal Pseudo-Obstruction ; Korea ; Male ; Myenteric Plexus ; Pathology ; Recurrence ; Ulcer

No abstract available.
Intestinal Pseudo-Obstruction*

Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder characterized by a severe impairment of gastrointestinal propulsion in the absence of mechanical obstruction. We experienced a case of chronic pseudo-obstruction in the initial phase mimicking acute pseudo-obstruction, which was treated medically. This ongoing case was compared to another recurrent and intractable case successfully treated with surgery and diagnosed as hypoganglionosis. These two cases showed different clinical features and therapeutic approaches for CIPO; one with the first episode of CIPO mimicking Ogilvie's syndrome; the other with recurrent episodes of CIPO with typical features. In conclusion, CIPO is a difficult disorder with various clinical manifestations and different treatment modalities, therefore individualized diagnostic and therapeutic approaches are needed.
Colon ; Intestinal Pseudo-Obstruction