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Chronic Intestinal Pseudo-Obstruction

CIPO


Presentation

  • Involvement is often present throughout the intestine so that patients may present with a variety of symptoms deriving from the esophagus, stomach, small intestine, and colon.[ncbi.nlm.nih.gov]
Vomiting
  • Nutrition supplementation is required for many patients with CIP due to symptoms of dysphagia, nausea, vomiting, and weight loss.[ncbi.nlm.nih.gov]
  • They tell you to breathe and relax while they insert the probe, but you are busy, choking, gagging, and often vomiting the probe back up on it's way down.[sarasarmy.com]
Abdominal Pain
  • At the age of 9 years, an isolated colonic stenosis without dilatation responsible for severe abdominal pain and altered quality of life led to digestive derivation contributing to rapid disappearance of chronic abdominal pain.[ncbi.nlm.nih.gov]
Nausea
  • Nutrition supplementation is required for many patients with CIP due to symptoms of dysphagia, nausea, vomiting, and weight loss.[ncbi.nlm.nih.gov]
  • Symptoms include but are not limited to: nausea vomiting severe pain abdominal distention constipation and or diarrhea weight loss early satiety (feeling very full very quickly) Diagnosing CIPO can be very difficult.[sarasarmy.com]
Abdominal Distension
  • A 59-year-old woman presented to our hospital with a 6-month history of nausea, weight loss, and abdominal distension.[ncbi.nlm.nih.gov]
Colic
  • We report a case of a 21 y old man who was diagnosed as CIPO with a history of recurrent intestinal colic and obstructive symptoms, slow transit type of constipation, bilateral hydronephrosis (non-obstructive), motor dysphagia without any evidence of[ncbi.nlm.nih.gov]
  • The three in whom an ileo-colic anastomosis was done required an ileo-rectal Duhamel pull through to relieve obstructive symptoms. Six children had an ileo-rectal Duhamel pull through with good outcome.[adc.bmj.com]
  • […] of intestinal pseudo-obstruction can include abdominal pain, nausea, severe distension, vomiting, dysphagia, diarrhea and constipation, depending upon the part of the gastrointestinal tract involved. [2] In addition, in the moments in which abdominal colic[en.wikipedia.org]
  • Large-intestine colic due to sympathetic deprivation; a new clinical syndrome.Br Med J. 1948; 2: 671-673. De Giorgio R, Barbara G, Stanghellini V, Tonini M, Vasina V, Cola B, et al.[sapd.es]
  • Large-intestine colic due to sympathetic deprivation; a new clinical syndrome. Br Med J. 1948 Oct 9. 2(4579):671-3. [Medline]. Ohkubo H, Iida H, Takahashi H, et al.[emedicine.medscape.com]
Hypoplastic Nails
  • Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive disorder characterized by hypoplastic nails, polydactyly, and achondroplasia. Patients usually exhibit normal cognitive function and no remarkable developmental delay.[ncbi.nlm.nih.gov]
Brachydactyly
  • The patient also had a short small bowel without malrotation, brachydactyly, and absence of the 2(nd) to 4(th) middle phalanges of both hands. The patient was treated with cisapride and combined parenteral and enteral nutritional support.[ncbi.nlm.nih.gov]

Workup

  • Histopathologists need to follow a systematic approach comprising of diligent histological examination and use of immunohistochemistry, immunocytochemistry, and electron microscopy in CIP workup.[ncbi.nlm.nih.gov]

Treatment

  • Treatment with cisapride substantially improved the patient's symptoms and improved feeding tolerance. It improved his prognosis remarkably and prevented the need for end-of-life care.[ncbi.nlm.nih.gov]

Prognosis

  • It improved his prognosis remarkably and prevented the need for end-of-life care. He experienced no adverse effects throughout the course of therapy. The treatment regimen is discussed in this case report.[ncbi.nlm.nih.gov]

Etiology

  • The latter form can be diagnosed early in life due to a genetic etiology or in adulthood when a viral origin may be considered.[ncbi.nlm.nih.gov]

Epidemiology

  • This review discusses the epidemiology, etiology, pathogenesis, diagnosis, and treatment of patients with CIP, with an emphasis on nutrition assessment and treatment options for patients with nutrition compromise.[ncbi.nlm.nih.gov]
  • Epidemiology and Clinical Experience of Chronic Intestinal Pseudo-Obstruction in Japan: A Nationwide Epidemiologic Survey. J Epidemiol 2013;23:288-294. Ohkubo H, Nakajima A et al.[cipo-information.com]
  • Summary Epidemiology The prevalence remains unknown. The male-to-female ratio is about 1.5:1 to 4:1.[orpha.net]
  • An epidemiologic survey of chronic intestinal pseudo-obstruction and evaluation of the newly proposed diagnostic criteria. Digestion. 2012. 86(1):12-9. [Medline]. Saunders MD. Acute colonic pseudo-obstruction.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The two pathophysiologic types of this motility disorder are myopathic and neuropathic. The latter may affect extrinsic or intrinsic neural control of gut motility.[ncbi.nlm.nih.gov]
  • Although the underlying cause of idiopathic intestinal pseudoobstruction is unknown, the primary pathophysiologic dysfunction in patients with idiopathic pseudoobstruction is a disorganization or lack of smooth muscle contractility that results in disordered[pediatrics.aappublications.org]

Prevention

  • It improved his prognosis remarkably and prevented the need for end-of-life care. He experienced no adverse effects throughout the course of therapy. The treatment regimen is discussed in this case report.[ncbi.nlm.nih.gov]
  • It usually prevents the body from absorbing nutrients. As a result, many children suffer from malnutrition, failure to thrive, and weight loss.[childrenshospital.org]
  • The main aim of management is to deliver adequate nutrition to the child and prevent damage occurring to the bowel. Most children manage to feed orally (by mouth), but may require supplements to meet their nutritional needs.[gosh.nhs.uk]

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