Intestinal Pseudo-Obstruction

Intestinal pseudo-obstruction is characterized by the dilation of bowel in the absence of an anatomical obstruction. Patients present with the signs and symptoms of bowel obstruction, including nausea, vomiting, abdominal distension, and obstipation with bowel dilation on x-ray or CT imaging. Pseudo-obstruction can be acute or chronic. Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, most commonly affects the large intestine from the cecum to the splenic flexure. The exact pathophysiology is unknown, but it has been linked to dysregulation of the autonomic nervous system. Most cases are found in patients who have undergone surgery or are critically ill. After a mechanical obstruction is ruled out, initial management includes bowel rest, nasogastric decompression, intravenous fluid resuscitation, and treatment of the underlying cause. Further treatment options include administration of Neostigmine as well as endoscopic, percutaneous, or surgical decompression. Chronic intestinal pseudo-obstruction (CIPO) is a more rare form of pseudo-obstruction, usually causing early satiety, nausea, bloating, and distension.  Causes are usually infectious, metabolic, neurologic, autoimmune, or idiopathic.