Intestinal Pseudo-Obstruction

An intestinal pseudo-obstruction is an uncommon condition where the intestines have all the signs of being obstructed, but there is not a true mechanical obstruction present. Unlike a true bowel obstruction, there is no actual blockage of the intestinal tract in a pseudo-obstruction. This is why it is known as a "pseudo" obstruction: pseudo means "artificial" or "mock." This is not to say that it is not a real condition, or that it is something that a person makes up. It is a very real problem.

The cause is not understood, but there are some known risk factors. With a pseudo-obstruction, the small or the large intestine are not moving food and waste material through as they do when the gastrointestinal tract is healthy.

Signs and Symptoms

Many of the signs and symptoms of a pseudo-obstruction are similar to those that occur with other digestive diseases. It is important to see a physician if any of the following signs or symptoms are severe, or if you have been diagnosed with a pseudo-obstruction in the past.

• Abdominal pain, which may be crampy in nature
• Abdominal swelling or distention
• Constipation, which is fewer than 3 bowel movements in a week
• Nausea and vomiting
• Nutritional deficiencies
• Unintentional weight loss

Risk Factors

A pseudo-obstruction is more common in the very young and the very old, but it can happen to just about anyone. When it comes on suddenly, it is known as "acute," and when it happens more slowly or repeatedly, it is called "chronic." There are a few known risk factors for pseudo-obstruction:

• Nervous System Disease: A disease such as cerebral palsy that affects the nervous system can interfere with the motility of the digestive tract.
• Immobility: Being unable to get out of bed and move around is another risk factor for pseudo-obstruction.
• Pain Medications: Certain pain medications, specifically narcotics, can alter the functioning of the intestines.

Diagnosis

First, a physician must rule out a more common cause to explain the symptoms, such as a physical obstruction or a tumor. Testing will usually begin with blood tests and may next move on to x-ray studies, such as a plain x-ray or computed tomography (CT). Depending on the specific symptoms and results, further testing beyond these is sometimes necessary, but as its name suggests, pseudo-obstruction is not associated with more typical reasons for the symptoms.

Treatment

Medical treatment of pseudo-obstruction can include drugs that stimulate the colon to move the waste material along, such as certain antibiotics, dopamine antagonists, and somatostatin analogs. Other medications may be given to help relieve the associated symptoms of nausea, vomiting, and pain. Any underlying vitamin and mineral deficiencies that were caused by the pseudo-obstruction will also require treatment.

In some cases, enteral nutrition (nutrients are given via a nasogastric (NG) tube may be needed until a patient can eat solid food again. Decompression, to let trapped air out of the intestinal tract either through a nasogastric (NG) tube or colonoscopy, may also be used as a treatment. If the pseudo-obstruction is caused by a medication, stopping that medication will help in getting the intestines moving again. 

In some rare cases, surgery might be necessary. Surgery will usually involve removing a section of the intestine. This might not cure the problem, because a pseudo-obstruction typically affects the entire small or large intestine. This is why surgery is not typically used. 

Related Conditions

Primary intestinal pseudo-obstruction, acute colonic ileus, colonic pseudo-obstruction, idiopathic intestinal pseudo-obstruction, Ogilvie's Syndrome