Pseudo-pseudo-obstruction. A clinically relevant concept.
Four patients with small bowel obstruction were treated nonoperatively after being misdiagnosed as chronic idiopathic intestinal pseudo-obstruction. Three patients with pseudo-pseudo-obstruction developed significant morbidity, and one patient died while being treated medically. Differentiation between pseudo-obstruction and mechanical obstruction can be difficult and may require laparotomy to establish the diagnosis. Intestinal manometry suggested a mechanical cause for obstruction in two patients and should be done in all patients that carry the diagnosis of intestinal pseudo-obstruction. Other clues to the diagnosis of intestinal pseudo-obstruction are discussed. Intestinal pseudo-obstruction is an uncommon disease that should not be a diagnosis of exclusion but should be diagnosed using historical, radiographic, manometric, pathologic, and operative data.
Richards
W
W
Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Williams
L F
LF
D000368:Aged; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis*; D007415:Intestinal Obstruction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D007418:Intestinal Pseudo-Obstruction / Q000175:diagnosis*; D007443:Intussusception / Q000175:diagnosis; D007579:Jejunal Diseases / Q000175:diagnosis; D008297:Male; D008365:Manometry; D008875:Middle Aged; D000267:Tissue Adhesions