Chronic idiopathic pseudo-obstructive bowel disease.

An illness characterized by recurrent episodes of small bowel obstruction is described. The patient, a 79-year old gentleman has been followed for 20 years. During this time he has hospitalized 19 times. Extensive investigation, including three exploratory laparotomies, have failed to show a cause of the bowel dysfunction. The clinical findings have been similar on each admission. Cramping abdominal pain, vomiting, obstipation often followed by diarrhea, tender distended abdomen, high pitched bowel sounds and abdominal x-rays revealed dilatation of small and large intestine and delayed gastric emptying on various admissions. The failure to demonstrate a recognized etiology for the repeated bowel obstruction over a long period of time warrants a clinical diagnosis of chronic idiopathic intestinal pseudo-obstruction (C.I.I.P.). The age of the patient at the onset of symptoms and the duration of the dysfunction prompted a review of the literature. Twenty-seven reported cases allowed a comparison of this case with the clinical features previously described. Symptomatic therapy, consisting of small bowel decompression by intestinal intubation during the acute episode, was followed by the use of elemental diets given slowly and continuously during the convalescing period. The patient continues to be comfortable and able to maintain his body weight between episodes which, however, seem to be increasing in frequency.