A case of chronic intestinal pseudo-obstruction secondary to primary visceral myopathy.
BACKGROUND
A 13-year-old girl presented to the emergency room at her local hospital with an acute onset of vomiting, severe abdominal pain and distension. There was evidence of small-bowel obstruction on plain abdominal x-ray. Throughout the girl's adolescent years she was admitted to hospital numerous times for recurrent abdominal symptoms and underwent multiple sequential laparotomies. She had marked weight loss and a poor quality of life. The patient's symptoms were initially managed with intravenous fluids, bowel rest, and nasogastric decompression of the upper gut.


METHODS
Peripheral blood tests with biochemistry and measurement of serum folate, vitamin B(12), albumin, 25-hydroxyvitamin D, inflammatory markers, autoantibodies and thyroid function; gastrointestinal imaging (plain abdominal x-ray, small-bowel series, colonic transit study, and abdominal CT with oral contrast); MRI of the brain and lumbar puncture; upper endoscopy; and laparotomy with sero-muscular biopsy of the small bowel.


METHODS
Chronic intestinal pseudo-obstruction secondary to primary visceral myopathy.


RESULTS
Prokinetic agents including oral cisapride and tegaserod, a venting gastrostomy, and total parenteral feeding.
Shim
Lisa S E
LS
Department of Gastroenterology, Nepean Hospital, Penrith, NSW, Australia.
Eslick
Guy D
GD
Kan
Alex E
AE
Kalantar
Jamshid S
JS
D000293:Adolescent; D001706:Biopsy; D002908:Chronic Disease; D020117:Cisapride / Q000008:administration & dosage; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D007211:Indoles / Q000008:administration & dosage; D007418:Intestinal Pseudo-Obstruction / Q000150:complications* / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010289:Parenteral Nutrition, Total; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
D005765:Gastrointestinal Agents; D007211:Indoles; D017366:Serotonin Receptor Agonists; C105050:tegaserod; D020117:Cisapride