Disorders of Small and Large Intestine : Colonic Pseudo-Obstruction = Disorders of Small and Large Intestine : Colonic Pseudo-Obstruction

다국어 초록 (Multilingual Abstract)

Background/Alms: Pseudoobstruction occurs in the absence of mechanical obstruction, thus is thought to result from impaired bowel motility. The characteristic symptoms are nausea, vomiting, abdominal distension and constipation. Neuroparhic disorders more common and may be primary or secondary (eg, fetal alcohol syndrome, ischemic events, viral infections). Methods: A 45-year old women presented with a one-month history of nausea, vomiting and poor oral intake. The patient had history of epilepsy and had been took valproate daily since she was middle school age. Results: On examination, the patient had abdominal distension and tympanic sound on the abdomen at percussion. Laboratory test were unremarkable. A plain abdominal radiograph showed marked distended colonic bowel gas (Fig. 1). There was no visible peristalsis at ascending and transverse colon. A computed tomographic scan of the abdomen showed abnormal cystic dilatation of large bowel loop of the cecum, ascending and transverse colon. The most severely dilated portion of the colon is about. 11 cm in diameter (Fig. 2). There was no evidence of mass or stricture. There was air density in the rectum on the simple abdomen, we excluded the presence of the mechanical obstruction of the colon, and diagnosed as colonic pseudo-obstruction. She was slightly improved after administration of intravenous neostigmine. But symptom was aggravated two days later. The patient underwent operation with total colectomy. She has subsequently shown a steady improvement after operation, remains free of symptoms until present. Conclusions: Colonic decompression with nasogastric tubes, enemas, rectal tubes and colonoscopy may be helpful. Also administration of intravenous neostigmine may be beneficial. Inspite of these treatments, surgical colectomy should be considered as decompression treatment.