Utility of orcein stain and comparison with Masson trichrome stain in chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIPO) is caused by a plethora of primary and secondary causes, dominantly involving the neuromuscular tissue, interstitial cells of Cajal, or the connective tissue framework. The lack of the connective tissue framework, known as desmosis, is evaluated by Masson's trichrome (MT) or picrosirius red stains, both of which are recommended in the London classification. We evaluated the orcein stain in detecting desmosis in comparison to the MT stain. We performed both orcein and MT stains in six previously published cases of complete or partial desmosis along with six age-matched controls. Our results showed comparable results of the orcein stain as compared to the MT stain. Additional advantages of lower cost and a clearer background in orcein stain were noteworthy, whereas MT stain can be used for the detection of additional pathology. We believe that orcein stain can be used as a cheap alternative in resource-limited settings.

Current Status in Management of Chronic Idiopathic Intestinal Pseudo-obstruction / 胃肠病学

Chronic intestinal pseudo-obstruction (CIPO) is a rare and serious motility disorder in gastrointestinal tract, which mimics mechanical intestinal obstruction clinically. It may be primary (idiopathic CIPO) or secondary to a organic, systemic or metabolic disorder. The etiology and mechanism of idiopathic CIPO are not yet clear. It might be linked to neuromuscular disorders of the digestive tract. Although there are a variety of diagnostic approaches, no standard diagnostic criterion has been achieved. Improper and delayed treatment may cause the increase in mortality. In this review article, the current status in management of idiopathic CIPO was summarized.

Diagnosis and treatment of chronic intestinal pseudo-obstruction / 中国实用外科杂志

Chronic intestinal pseudo-obstruction(CIPO)is a rare but serious intestinal dyskinesia characterized by impaired bowel motor function in the absence of mechanical intestinal obstruction. CIPO may be caused by primary and secondary factors that damage the enteric nervous system(neuropathy),smooth muscle(myopathy),and/or Cajal interstitial cells(interstitial disease). CIPO is extremely easy to missed diagnosis and misdiagnosis.The treatment of CIPO is very difficult.It is based on nutritional support,medicine and surgical treatment.At present,the occurrence,development and treatment of intestinal micro-ecology in CIPO has gradually attracted attention and may become a new treatment method for CIPO.

Study progress of chronic intestinal pseudo-obstruction in children / 中华实用儿科临床杂志

Chronic intestinal pseudo-obstruction(CIPO)is an intestinal motility dysfunction caused by intestinal myopathies or neuropathies or mesenchymopathies.The clinical manifestation is almost the same with mechanical intestinal obstruction,but in the absence of any obstruction in the gastrointestinal tract.According to etiology,it can be divided into primary and secondary.While according to gastrointestinal neuromuscular disorders,it can be categorized as myopathy,neuropathy and mesenchymopathy,which have different pathogenesis.The disease with the clinical manifestation,imaging examination or histopathology was diagnosed,but mechanical intestinal obstruction must be excluded.Presently,the therapies of CIPO mainly are stimulating the motility of intestine and ensuring the necessary nutrition of the children.The review is mainly focused on the research progress of the pathogenesis,clinical manifestation,diagnosis,therapy of pediatric CIPO in recent years.

Sobrecrecimiento bacteriano intestinal y pseudoobstrucción intestinal crónica: una relación poco conocida / Small intestinal bacterial overgrowth and chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIP) is the most severe intestinal motility disorder. Small intestinal bacterial overgrowth (SIBO) is frequently associated to dysmotility. In spite of this association, there is scare data on the relation between CIP and SIBO. To establish occurrence of CIP in SIBO patients in inter-crisis periods. To compare clinical and manometric characteristics of SIBO and non-SIBO patients. Retrospective analysis of 40 CIP patients (average age: 41 years; range: 18-76 years; 75 percent women). The following elements were registered: symptoms (such as pain, distention, vomit, constipation, diarrhea and weight loss); findings of the intestinal manometry (neuropathic, miopatic and mix pattern; intestinal motility index); and SIBO using lactulose H2 breath test, defined as an increase > 20 ppm in 2 or more figures in the first 60 minutes. Statistical analysis: t-test y and comparison of two ratios. SIBO was observed in 60 percent of the patients with CIP. Three or more symptoms were observed in 70.8 percent of the patients with SIBO 50 percentwithout SIBO (p = NS). In patients with SIBO, the most frequent symptom was abdominal pain (70.8 percent p= 0.032). There were no differences between SIBO patients and the different motility patterns, however, the intestinal motility index was lower for the SIBO group (9.7 +/- 44 12.3 +/-7; p < 0.001). : There is a high prevalence of SIBO in CIP patients. This is associated to a major compromise of intestinal motility assessed by the intestinal motility index...

Introducción: La pseudoobstrucción intestinal crónica (POIC) es el trastorno más grave de la motilidad intestinal. El sobrecrecimiento bacteriano intestinal (SBI) se asocia frecuentemente a estados de dismotilidad. A pesar de esta asociación existen escasos datos sobre la relación entre POIC y SBI. Objetivo: Determinar SBI en pacientes con POIC en período inter-crisis. Comparar características clínicas y manométricas de pacientes con y sin SBI. Material y Método: Análisis retrospectivo de 40 pacientes con POIC (edad promedio: 41 años, rango: 18-76 años; 75 por ciento mujeres). Se registraron síntomas (dolor, distensión, vómitos, constipación, diarrea, baja de peso), hallazgos en manometría intestinal (patrón neuropático, miopático o mixto, índice de motilidad intestinal (IMI)) y SBI con test de H2 con lactulosa, definido como la elevación > 20 ppm en 2 o más cifras en los primeros 60 min. Análisis estadístico: t-test y comparación de 2 proporciones. Resultados: Se observó SBI en 60 por ciento de los pacientes con POIC. Tres o más síntomas se presentaron en 70,8 por ciento de los pacientes con SBI vs 50 por ciento en POIC sin SBI (p = NS). El síntoma dolor abdominal fue más frecuente en pacientes con SBI (70,8 por ciento vs 31,2 por ciento, p = 0,032). No hubo diferencias entre pacientes con SBI y los distintos patrones de motilidad, sin embargo, el IMI fue menor para el grupo con SBI (9,7 +/- 1,44 vs 12,3 +/- 1,7, p < 0,001). Conclusiones: Existe una alta prevalencia de SBI en pacientes con POIC. Esto se relaciona con mayor compromiso de la motilidad intestinal evaluado por el IMI.

Repetitive Colonoscopic Decompression as a Bridge Therapy before Surgery in a Pregnant Patient with Chronic Intestinal Pseudo-Obstruction

Chronic intestinal pseudo-obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors. Here, we report a case of a woman with intractable intestinal pseudo-obstruction that was precipitated by pregnancy. She could not make any stool passage for more than 4 weeks until a fetal gestational age of 17 weeks was reached. However, the patient could be maintained by repetitive colonoscopic decompressions and finally total colectomy could be performed successfully at a fetal gestational age of 21 weeks.

Primary chronic intestinal pseudo-obstruction / 肠外与肠内营养

s:Primary chronic intestinal pseudo-obstruction (PCIPO)is a rare digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases. This article is aimed at reviewing the current knowledge on etiology, clinical features and management of patients affected by PCIPO.

Intestinal Neuronal Dysplasia / 대한소화기학회지

Intestinal neuronal dysplasia (IND) type B is a disease of the submucosal plexus of intestine manifesting chronic intestinal obstruction or severe chronic constipation. IND is one of intestinal dysganglionoses and clinically closely associated with Hirschsprung's disease. Until recently, it is not fully clear whether IND is a congenital malformation or an acquired secondary condition related to some gastrointestinal problems. However, recently published data and consensus reports have enhanced our understanding of the pathogenesis and management of IND. The aim of this paper was to review the current state of knowledge regarding the controversial issues of IND including the etiology, classification, diagnostic criteria, and available therapeutic intervention.

A Very Rare Cause of Chronic Intestinal Pseudo-Obstruction: Sopradic Visceral Myopathy / 대한소화관운동학회지

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a rare clinical condition in which impaired intestinal propulsion causes recurrent symptoms of bowel obstruction in the absence of mechanical obstruction. CIPS can be present as either primary or secondary although the latter is rare in children compared with adults. The primary abnormality consists of a degeneration of either the muscularis propria (visceral myopathy), or the myenteric plexus (visceral neuropathy). A 19 year old woman was recently admitted with recurrent abdominal distension and diarrhea. An abdominal plain X-ray revealed a marked dilated stomach and duodenum with some air-fluid levels. A small bowel series showed a diffusely dilated small bowel with multifocal angulation and spiculation. Computed tomograpy also revealed a dilated small bowel and distal ileal wall thickening. The patient was treated by duodenojejunostomy and ileal resection. Histologically the intestine showed thinning of the proper muscle layer with degeneration of smooth muscle cells replaced by fibrosis. Based on the specific histopathologic finding, in addition to the clinical history, physical finding and radiological evaluation, a diagnosis of sporadic visceral myopathy was rendered. The patient was treated through total parenteral nutrition with neostigmine, prokinetics, octreotide, and erythromycin postoperatively. However, she underwent ileostomy due to poor response from these therapies. After ileostomy, she improved without a recurrence of severe symptoms.

A Very Rare Cause of Chronic Intestinal Pseudo-Obstruction: Sopradic Visceral Myopathy / 대한소화관운동학회지

Chronic intestinal pseudo-obstruction syndrome (CIPS) is a rare clinical condition in which impaired intestinal propulsion causes recurrent symptoms of bowel obstruction in the absence of mechanical obstruction. CIPS can be present as either primary or secondary although the latter is rare in children compared with adults. The primary abnormality consists of a degeneration of either the muscularis propria (visceral myopathy), or the myenteric plexus (visceral neuropathy). A 19 year old woman was recently admitted with recurrent abdominal distension and diarrhea. An abdominal plain X-ray revealed a marked dilated stomach and duodenum with some air-fluid levels. A small bowel series showed a diffusely dilated small bowel with multifocal angulation and spiculation. Computed tomograpy also revealed a dilated small bowel and distal ileal wall thickening. The patient was treated by duodenojejunostomy and ileal resection. Histologically the intestine showed thinning of the proper muscle layer with degeneration of smooth muscle cells replaced by fibrosis. Based on the specific histopathologic finding, in addition to the clinical history, physical finding and radiological evaluation, a diagnosis of sporadic visceral myopathy was rendered. The patient was treated through total parenteral nutrition with neostigmine, prokinetics, octreotide, and erythromycin postoperatively. However, she underwent ileostomy due to poor response from these therapies. After ileostomy, she improved without a recurrence of severe symptoms.

A case of chronic intestinal pseudo-obstruction syndrome

No abstract available.