Symptoms and medical history

Intestinal pseudo-obstruction may affect the whole gut or only parts of it. In Hirschsprung's disease, for example, only a short segment of the rectum is usually affected. In achalasia progressive neuropathy with loss of neural function affects the lower portion of the oesophagus and the cardia leading to abnormal spasm. In the majority of cases, however, pseudo-obstruction is a generalised disorder involving not only the gastrointestinal tract but other hollow viscera like the urinary or the biliary system. The clinical presentation in pseudo-obstruction depends upon the region of gut that is affected:

Segment	Region	Symptoms
Foregut	Oesophagus-prox. duodenum	Dysphagia, vomiting, nausea
Midgut	Dist. duodenum-right colon	Abd. pain, distension, constipation
Hindgut	Left colon-rectum	Constipation, distension, abd. pain

Symptoms of pseudo-obstruction may have a pronounced variation over time. Episodes of severe symptoms may alternate with periods of little or even no symptoms. In many patients, however, symptoms are more or less chronic. A common presentation in mid-gut disease as well as in generalised pseudo-obstruction is that of recurrent subileus episodes which may lead the clinician to perform laparotomy in hope of finding a mechanical obstruction of the bowel. In fore-gut disease recurrent vomiting, in particular a few hours after a meal is common whereas in hind-gut disease the most common presentation is probably slow transit constipation.

Many cases of pseudo-obstruction seem to occur by chance in single individuals but in others a family history may exist. Several familial forms of visceral myopathy and neuropathy have been described in the literature (see for example Christensen et al. 1990) and the search for hereditary information in suspected pseudo-obstruction is essential.

General

Symptoms and medical history

Scientific