Colon
Congenital anomalies
Chronic intestinal pseudo-obstruction


Topic Completed: 1 May 2013

Minor changes: 7 December 2020

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PubMed Search: Colon[title]Chronic intestinal pseudo-obstruction

Hanni Gulwani, M.B.B.S.
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Cite this page: Gulwani H. Chronic intestinal pseudo-obstruction. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonchronicintest.html. Accessed April 18th, 2021.
Definition / general
  • Syndrome of intestinal obstruction without mechanical obstruction
  • Usually a small bowel disorder but can occur anywhere in GI tract
  • Ogilvie's 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 (antiParkinson, clonidine, ganglionic blockers, phenothiazines, tricyclic antidepressants) or idiopathic (cathartic colon, ceroidosis, Hirschsprung's 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
Case reports
Treatment
  • Diet, octreotide, surgery, transplant
Microscopic (histologic) description
  • Visceral myopathy: 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 (Am J Surg Pathol 1987;11:846)
  • 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: especially inner layer

Muscularis propria degeneration:
muscle fiber loss,
degenerative changes,
collagen replacement

Muscularis mucosa:
degenerative changes
of fibers (vacuolation
and pyknotic nuclei)

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
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