Chronic Intestinal Pseudo-Obstruction

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Chronic intestinal pseudo-obstruction (CIPO) is a rare gastrointestinal motility disorder characterized by recurring episodes resembling mechanical obstruction in the absence of organic, systemic, or … Read More

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Chronic Intestinal Pseudo-Obstruction

Chronic intestinal pseudo-obstruction (CIPO) is a rare gastrointestinal motility disorder characterized by recurring episodes resembling mechanical obstruction in the absence of organic, systemic, or metabolic disorders, and without any physical obstruction being detected by X-ray or during surgery. CIPO develops predominantly in children and may be present at birth.  There is muscle contraction inside of the gastrointestinal tract which is called motility. Peristalsis is used to ensure normal functioning and nutrients absorption. This process involves the use of the alimentary canal to stimulate diet with the help of contractions. These contractions are usually between never, hormones and muscles in the alimentary canal on which peristalsis relies. Chronic intestinal pseudo-obstruction generally results in nerves or muscle abnormalities which make peristalsis ineffective. Chronic intestinal pseudo-obstruction mainly breaks into two parts depending upon the involvement of the nerves or muscles of the alimentary canal. This problem is somewhat identical to mechanical obstruction. However, the prediction of chronic intestinal pseudo-obstruction differs from mechanical obstruction. 

Diagnosis

Several tests are available to diagnose chronic intestinal pseudo-obstruction easily. For some tests, the patient needs to follow some guidelines and should be physically stable. Primary diagnosis includes blood tests for blood count, certain infection, and anaemia, deficiency of nutrition, growth of bacteria which results in infection, SED rate to check inflammation of the body, serum electrolyte level, albumin and level of thyroid hormone in the body along with platelet count. These tests are necessary for an overview of the disease and treatment. X-rays and CT scanning is employed for a clear detailed analysis. Often MRI is also done for high-quality images of abdominal tissues.  To estimate the contraction in the intestinal tract manometry test is performed. It is conducted to determine the hidden causes and to inspect the oesophagus abnormalities. The biopsy can be done according to the severity of pseudo-obstruction. In a biopsy, tissues of nerves or muscles are detached to scrutinize the problem microscopically.

Treatment

Mild symptoms can be treated with light medications but in case of severe chronic intestinal pseudo-obstruction, surgery can be employed.  Bowel surgery- surgery used to treat pseudo-obstruction is called bowel resection. Firstly, the bowel comprises the rectum and large and small intestine. In this surgery, the doctor removes the affected part of the bowel to cure the disease. Normally, the blocked pathway is cured using this method. It causes comfort and pain in the rectum due to abnormal functioning. Bowel surgery can be done if the patient is diagnosed with certain intestinal cancer, infections in the abdomen, severe bleeding and blocked pathway of the alimentary canal.  Bowel surgery can be done in two ways namely laparoscopic resection and open resection. The choice of surgery depends on the seriousness of the problem, location of the problem and size of the problem. 

Preparation for bowel resection surgery

The patient should stop all the medications at least one week before the surgery, consume a liquid diet to vacate the bowels and avoid unhealthy practice like smoking and drinking to reduce the chances of complications. The patient may need to overnight before the surgery in the hospital. He must take only liquids as a diet and should not eat or drink anything at least 12 hours before the surgery. Bring all the reports for reference and bring the necessities of one to two weeks as the patient will be under medical attention for some time. 

The procedure of bowel resection surgery

Initially, anaesthesia is administered to numb the pain. For open surgery, a large cut is made in the abdomen area whereas, for laparoscopic surgery, several small cuts are made in the abdomen. In open surgery, there is enough space for the tool to be inserted while gas is filled in the area in laparoscopic surgery to provide space for tools. A tube is used to check the disease with a camera fixed on the head. The diseased area is cut from the organ. The remaining part is stitched along with the main cut and the incision area is rinsed to avoid infection.  

Recovery from surgery

Recovery can take a few weeks. Usually, two or four weeks rest is required in the hospital for regular observation. The patient can drink or eat after some time. A fibrous diet is helpful. The patient can recover from laparoscopic surgery faster as compared to open surgery.  The patient can recover entirely after 5-6 weeks. Though he can return to his normal life in 2 weeks. Weightlifting, straining and heavy exercises are prohibited for a long period.

Benefits of surgery

Laparoscopic surgery has faster recovery, the pain is less or none at all and the risks of scars are extremely low. The patient can eat anything after some time. This surgery provides better results and reduces the chances of future intestinal infections.  Colectomy- another surgery to treat chronic intestinal pseudo-obstruction is colectomy which cures diseases of colon such as diverticulitis, cancer and inflammation. It is similar to laparoscopic bowel resection surgery as a part of the colon is detached from the intestine. The recovery rate is faster in colectomy either laparoscopic or open, mostly 3-4 days. The colectomy is painless as anaesthesia is given to the patient during surgery. The diet for some time will be liquid to avoid pressure on the intestine. Yoghurt, soup, energy drinks, fruit juices and gelatine are recommended to provide energy. The food which must be avoided is meat, egg, bread, chewy food, deep-fried and spicy food which leads to gas in the abdomen. Further to prevent the development of gas one must avoid intake through a straw, avoid smoking and tobacco and avoid chewing gums. 

Prevention of chronic intestinal pseudo-obstruction

To avoid intestinal problems one should eat fibre rich foods like figs, apples, milk, almond, broccoli, bananas, cauliflower, pumpkin seeds, sunflower seeds, flax seeds and sprouts.

Symptoms

Patients commonly present with severe chronic “obstructive” symptoms: abdominal pain, distension/fullness, nausea/vomiting, diarrhea and/or intractable constipation, malabsorption of nutrients leading to weight loss and/or failure to thrive. Laboratory abnormalities usually reflect the degree of malabsorption and malnutrition. The radiological findings commonly include paralytic ileus or signs of apparent clinical obstruction with dilated loops of bowel. The regions of the gut affected may be isolated (small bowel involvement is the most typical) or diffuse, and sometimes other visceral musculature, such as the urinary bladder, is involved.

Causes

The causes of chronic intestinal pseudo-obstruction are many. They can be genetic in some cases or can occur as a result of another disease or disorder. Some severe problems of the digestive tract or oesophagus may lead to pseudo-obstruction.

It occurs mainly in children. Though it is a very rare disease. Usually, chronic intestinal pseudo-obstruction is characterised by neuropathic chronic intestinal pseudo-obstruction and myopathic chronic intestinal pseudo-obstruction. To elaborate it further, primarily the causes are divided into three categories birth-related, genetic related and random occurrence. It is known that in children, chronic intestinal pseudo-obstruction is primary and random whereas in adults it is secondary and random.

• Abdominal or pelvic surgery.
• Diseases that affect muscles and nerves, such as lupus erythematosus, scleroderma, and Parkinson's disease.
• Infections.
• Medications, such as opiates and antidepressants, that affect muscles and nerves.
• Radiation to the abdomen.

FAQ

What is the cost of the treatment of chronic intestinal pseudo-obstruction?

Bowel resection is an expensive surgery. It costs between $24,000 and $35,000. It can cost less if you have insurance cover and depending on the hospital facilities.

What are the complications of chronic intestinal pseudo-obstruction surgery?

Shortness of breath, heart attack, strokes, blood clotting, damage to other parts, pneumonia, bleeding from the incision, fluid leakage, hernia and scars.

How long does the treatment of chronic intestinal pseudo-obstruction take?

The treatment takes 3-4 hours for surgery. However, preparation takes a few more hours. The regular visits are necessary for some time to look after the healing process. 

What is the life expectancy of patients with chronic intestinal pseudo-obstruction?

Pseudo-obstruction is a life-threatening disease. The life expectancy of people with this disease is usually less as compared to others. The life of affected people is usually around 60-70 years. 

Can chronic intestinal pseudo-obstruction be cured?

Yes, it can be cured. In initial stages, mild medications are given but in intense situations, laparoscopic and open surgeries are available.