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Chronic intestinal pseudo-obstruction

Michael Camilleri, MD
Section Editor
Lawrence S Friedman, MD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Pseudo-obstruction is a syndrome characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of an anatomic lesion that obstructs the flow of intestinal contents. Pseudo-obstruction may be acute or chronic and is characterized by the presence of dilation of the bowel on imaging. When there is evidence of chronic small intestinal motility disorder in the absence of bowel dilatation, the preferred term is chronic intestinal dysmotility.

This topic review will discuss the etiology, clinical manifestations, diagnosis, and treatment of chronic intestinal pseudo-obstruction. Acute pseudo-obstruction, chronic intestinal dysmotility, and slow transit constipation/colon inertia are discussed separately. (See "Acute colonic pseudo-obstruction (Ogilvie's syndrome)" and "Etiology and evaluation of chronic constipation in adults".)


Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder that may be due to an underlying neuropathic disorder (involving the enteric nervous system or extrinsic nervous system), a myopathic disorder (involving the smooth muscle), or abnormality in the interstitial cell of Cajal (ICC) [1]. Therefore, there are parallels in the pathobiological mechanisms of CIPO and gastroparesis.

Neuropathic, myopathic, or ICC abnormalities may be idiopathic or secondary to another disease. Approximately half of the cases of CIPO are secondary to neurologic, paraneoplastic, autoimmune, metabolic/endocrine, and infectious diseases.

More than one of the elements of the neuromuscular apparatus of the gut may be affected in certain diseases. For example, there is an intrinsic neuropathic phase of scleroderma, before the smooth muscle involvement results in myopathy. Similarly, mitochondrial cytopathy results in neuropathy and eventually myopathy. Moreover, diabetes affects extrinsic nerves through autonomic neuropathy, and the ICCs and amyloidosis causes an extrinsic neuropathy followed by myopathic CIPO.

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Literature review current through: Nov 2017. | This topic last updated: Jul 18, 2016.
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