Clin Endosc.  2013 Sep;46(5):591-594.

Repetitive Colonoscopic Decompression as a Bridge Therapy before Surgery in a Pregnant Patient with Chronic Intestinal Pseudo-Obstruction

• Kim JS
• Lee BI
• Kim BW
• Choi H
• Lee YS
• Maeng L

Abstract

Chronic intestinal pseudo-obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors. Here, we report a case of a woman with intractable intestinal pseudo-obstruction that was precipitated by pregnancy. She could not make any stool passage for more than 4 weeks until a fetal gestational age of 17 weeks was reached. However, the patient could be maintained by repetitive colonoscopic decompressions and finally total colectomy could be performed successfully at a fetal gestational age of 21 weeks.

Keyword

Chronic intestinal pseudo-obstruction; Pregnancy; Colonoscopic decompression; Interstitial cells of Cajal

MeSH Terms

Colectomy
Decompression
Female
Gestational Age
Humans
Interstitial Cells of Cajal
Intestinal Obstruction
Intestinal Pseudo-Obstruction
Pregnancy

Figure

• 

  Fig. 1 Barium enema reveals no obstructive lesions.

• 

  Fig. 2 (A) The fecal bezoar is obstructing the colonic lumen. (B) A decompression rectal tube was inserted beyond the obstruction through the scope.

• 

  Fig. 3 Gross findings for the resected colon and terminal ileum. The colon measured 100 cm in length, and the proximal portion was dilated. The diameter of the dilated portion measured 16 cm. No perforation was found.

• 

  Fig. 4 H&E stained section of the colon reveals the presence of normal ganglion cells within the myenteric plexus (A, ×40; B, ×400).

• 

  Fig. 5 (A) CD117 immunohistochemical staining shows decreased numbers of interstitial cells of Cajal (ICCs) at the dilated portion of colon (×400). (B) The undilated portion of colon shows good distribution of ICCs (×400).

Reference

1. Faulk DL, Anuras S, Christensen J. Chronic intestinal pseudoobstruction. Gastroenterology. 1978; 74(5 Pt 1):922–931. PMID: 346432.

2. Luckas M, Buckett W. Acute colonic pseudo-obstruction in the obstetric patient. Br J Hosp Med. 1997; 57:378–381. PMID: 9274662.

3. ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004; 104:647–651. PMID: 15339791.

4. Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute colonic pseudo-obstruction. N Engl J Med. 1999; 341:137–141. PMID: 10403850.

5. Lyford G, Foxx-Orenstein A. Chronic intestinal pseudoobstruction. Curr Treat Options Gastroenterol. 2004; 7:317–325. PMID: 15238207.

6. Geller A, Petersen BT, Gostout CJ. Endoscopic decompression for acu te colonic pseudo-obstruction. Gastrointest Endosc. 1996; 44:144–150. PMID: 8858319.

7. Classen M, Tytgat GN, Lightdale CL, et al. Gastroenterological Endoscopy. 2nd ed. New York: Thieme;2010.

8. Cappell MS. Risks versus benefits of gastrointestinal endoscopy during pregnancy. Nat Rev Gastroenterol Hepatol. 2011; 8:610–634. PMID: 21970872.

9. De Giorgio R, Sarnelli G, Corinaldesi R, et al. Advances in our underst anding of the pathology of chronic intestinal pseudo-obstruction. Gut. 2004; 53:1549–1552. PMID: 15479666.

10. Choe EK, Park SH, Park KJ. Colonic pseudo-obstruction with distinct transitional zone in adult constipation patients: pathological analysis and results of surgical treatment. Am Surg. 2011; 77:736–742. PMID: 21679643.

11. Do MY, Myung SJ, Park HJ, et al. Novel classification and pathogenetic analysis of hypoganglionosis and adult-onset Hirschsprung's disease. Dig Dis Sci. 2011; 56:1818–1827. PMID: 21222160.