Intestinal Blockage


Pseudo obstruction, PO, Hirschsprung's disease, False Blockage, Ogilvie's syndrome

  • This refers to a group of rare disorders that involve a dysfunction of the small and the large intestines.
  • In conditions that cause PO, the nerves and muscles in the wall of the intestine that normally help with moving (gut motility) digested food material from the stomach to the rectum are often affected (damaged). When a section of the intestine is not contracting (muscles shortening), normal gut mobility (in that area) is compromised and food and digested material pile up as if there were something blocking their movement. However, since there is nothing blocking their path, the condition is referred to as pseudo (i.e., false) obstruction.

  • Most commonly, a long term chronic problem with symptoms daily or intermittent
  • The sections of the gut in which PO is present, can have bacterial overgrowth that may interfere with proper absorption of foods and other nutrients such as vitamins.
  • Most common symptom is abdominal pain -- usually cramping or colicky (comes and goes).
  • Bloated feeling as if there is excess gas in the belly
  • Nausea
  • Vomiting
  • Chronic or intermittent Constipation
  • The walls of the colon (large intestine) can enlarge and thin over years and may be in danger of rupturing (megacolon) -- this is a surgical emergency.

  • Congenital (present at birth):
    1. Hirschsprung's disease
    2. Symptoms are seen in infants
    3. Possibly genetic -- more predominant in males and families
  • Infection:

- Parasite-Trypanosoma cruzi (Chagas' Disease) seen in Central and South America.

  • Drugs:
    1. Antidepressants
    2. Opiates-morphine and codeine.
  • Diseases Affecting nerves:
    1. Parkinson's Disease
    2. Spinal cord injury
    3. Stroke
  • Diseases affecting muscles:
    1. Scleroderma
    2. Amyloidosis
    3. Dermatomyositis
    4. Muscular Dystrophy
    5. Others:
    6. Diabetes
    7. Myxedema
    8. Idiopathic -- without a cause

  • History:

    1. Symptoms
    2. Medications
    3. Surgeries
    4. Illnesses
    5. Family history
    6. Psychiatric history
    7. Habits
    8. Foods
  • Medical exam:
    1. Doctor may refer you to a gastroenterologist (gut doctor).
    2. The abdomen may be distended.
    3. There may be weight loss.
    4. There may be signs of other diseases.
    5. The doctor may perform a rectal examination using his index finger.
  • Tests:
    1. Blood tests, X-Rays (abdominal series), and special procedures such as endoscopy (looking inside with a flexible camera), CAT scans, Ultrasound (pictures using sound) and Barium Enema (X-Rays after patient drinks chalky dye) are often normal or of little help.
    2. Best diagnosis -- done by a physician who takes a good history and does a full exam.
    3. Gut pressure measurement and surgically removing a piece of the affected section (biopsy) and looking for the underlying cause -- done in some hospitals.

  • See causes
  • Ogilvie's Syndrome -- sudden PO seen in patients on respirators (mechanical breathing machines) or drugs, such as morphine, Valium, etc.
  • Prolonged bed rest, as in nursing homes or psychiatric wards
  • Constipation
  • Drugs

  • Treat the cause
  • Avoid prolonged periods of bed rest
  • Exercise regularly
  • Avoid drugs
  • Eat fruits, vegetables, and fish
  • Limit fried greasy foods, dairy, and other animal products
  • Vitamins and nutritional supplements may be helpful
  • Drink plenty of fluids
  • Avoid overuse of laxatives, opiates, and other drugs that constipate
  • During attacks of PO:
    1. Eat liquid foods like soups
    2. Medications to reduce or stop vomiting are helpful.
  • Nasogastric tube can be placed into the stomach to allow excess gas to escape.
  • Medications that increase motility such as erythromycin can be prescribed.
  • Fluids -- needed if vomiting for long time
  • Fluids -- given intravenously (in the blood) as needed.
  • Surgical intervention is rarely needed.

  • If you have sudden severe abdominal pain, vomit blood or vomit non-stop, have fever or brown/dark loose stool -- contact your doctor or call 911 immediately.