Chronic intestinal pseudo-obstruction diagnosed by antro-duodenal manometry in a patient having persistent symptoms despite surgical exploration – a case report

Introduction: Chronic intestinal pseudo-obstruction is a rare gastrointestinal motility disorder, which can only be diagnosed by means of antro-duodenal manometry. Although no specific and uniformly effective medical therapy exists, correct diagnosis is important, since it may prevent further unnecessary surgical procedures.

Case report: A 75 years old female patient was admitted to our department from the emergency unit due to diffuse abdominal pain, repeated vomiting, intermittent hyper-peristaltic bowel sounds and dilated small bowel loops on plain abdominal X ray. Since 2002 she was repeatedly hospitalised for similar symptoms and concomitant asthma. After having negative abdominal ultrasound, upper GI endoscopy and colonoscopy, a double contrast upper GI barium series was done, that demonstrated several non-peristaltic, dilated small bowel loops in the jejunum, with a suspected stenosis at the proximal ileum. Due to the failure of conservative therapy, surgical exploration was performed, but no intraoperative explanation of mechanical small bowel obstruction was found. 2 months later she was admitted to our department repeatedly due to recurrent symptoms. Finally, antro-duodenal manometry was performed with a Synectic perfusion manometric system and a 6 channel manometric catheter that successfully positioned into the distal duodenum. After 3 hours basal recording, a standard caloric meal was given, and manometry was continued for 2 hours. At the analysis of the recording, no inter-digestive motility patterns were noted, instead high amplitude, chaotic, bursts of contractions were detected both at the antral and also at the duodenal measurement ports, without any antro-duodenal co-ordination. Postprandially, there was no change of this pathological motility pattern, demonstrating a neuropathic type of chronic intestinal pseudo-obstruction. On medical therapy of PPI, metoclopramide and pinaverinum bromid she became asymptomatic and discharged.