Colon
Congenital anomalies
Chronic intestinal pseudo-obstruction
Author: Hanni Gulwani, M.B.B.S.
Last author update: 1 May 2013
Last staff update: 26 April 2022
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Colon[title]Chronic intestinal pseudo-obstruction
Table of Contents
Definition / general | Etiology | Prognostic factors | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Gulwani H. Chronic intestinal pseudo-obstruction. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonchronicintest.html. Accessed April 24th, 2024.
Definition / general
- Syndrome of intestinal obstruction without mechanical obstruction
- Usually a small bowel disorder but can occur anywhere in GI tract
- Ogilvie syndrome (acute colonic pseudo-obstruction): abrupt onset of abdominal distension (Radiol Med (Torino) 2005;109:370)
Etiology
- Gut motility depends on sympathetic (thoracolumbar) and parasympathetic (vagal) innervation to ganglionated plexi; also enteric nervous system, smooth muscle cells and interstitial cells of Cajal
- Results from autonomic imbalance resulting in sympathetic overactivity affecting some part of colon (Singapore Med J 2009;50:237)
- Usually congenital in children; in adults due to systemic disease (amyloidosis, Chagas disease, dermato / polymyositis, diabetes, muscular dystrophy, myotonic dystrophy, myxedema, scleroderma), drugs (anti-Parkinson, clonidine, ganglionic blockers, phenothiazines, tricyclic antidepressants) or idiopathic (cathartic colon, ceroidosis, Hirschsprung disease, visceral myopathies, visceral neuropathies)
- May be due to loss of interstitial cells of Cajal in small and large bowel (Am J Surg Pathol 2003;27:228)
Prognostic factors
- Often poor long term outcome (Clin Gastroenterol Hepatol 2005;3:449)
- High mortality if perforation or ischemia
Case reports
- 44 year old woman with intestinal amyloidosis with intractable diarrhea (Korean J Gastroenterol 2012;60:172)
- 71 year old woman with pseudo-obstruction with pitch black colon (Ulster Med J 2008;77:54)
- 2 cases of pseudo-obstruction in sickle cell disease (South Med J 2003;96:93)
Treatment
- Diet, octreotide, surgery, transplant
Microscopic (histologic) description
- Visceral myopathy (Am J Surg Pathol 1987;11:846):
- Vacuolar degeneration with swelling and loss of muscle cells, fibrosis of outer longitudinal muscle layer
- Other cases show cytoplasmic vacuoles, marked nuclear enlargement and irregularity and interstitial fibrosis
- May have segmental hypoganglionosis at transitional zone (Am Surg 2011;77:736)
Microscopic (histologic) images
Images hosted on other servers:
Familial autonomic visceral myopathy:
Muscularis propria degeneration
Muscularis mucosae with degenerative changes
Differential diagnosis
- Ischemic colitis:
- Hemosiderin deposits, fibrous stricture
- Scleroderma:
- Patchy bowel involvement, dense fibrosis affecting inner or all muscle layers, no vacuolar change
- Tuberculosis:
- Stricture, necrotizing granulomas
Additional references
