Chronic Colonic Pseudo-obstruction by Sporadic Degenerative Visceral Neuropathy

ABSTRACT

Chronic intestinal pseudo-obstruction is characterized by severe alteration to the intestinal motility, with clinical features that mimic those of a mechanical obstruction in the absence of any organic obstacle to the intestinal transit. The syndrome is induced by a disease of the muscle layer or intrinsic nerves. However, the sporadic degenerative non-inflammatory type of visceral neuropathy is rare. A 65-year-old woman was admitted to our institution due to chronic constipation and abdominal distention. She had a past history of admission due to repeated chronic constipation. An abdomen-pelvic CT revealed no evidence of an organic cause of the obstruction. Her colonic transit time was delayed. An anorectal manometry showed a normal rectoanal inhibitory reflex, but a decreased maximal pressure. A colon study revealed a pseudo-obstruction at the splenic flexure level. Her symptoms were not improved with conservative management; therefore, a subtotal colectomy was subsequently performed. The pathological diagnosis was that of sporadic degenerative non-inflammatory visceral neuropathy. The patient recovered uneventfully, and showed normal bowel movement during the follow-up period.