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Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: A real diagnostic challenge

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World Journal of Gastroenterology 2014年第32期20卷 11443-11450页

作者： Carlos Alberto García López Fernando Laredo-Sánchez José Malagón-Rangel Miguel G Flores-Padilla Haiko Nellen-Hummel Department of Internal Medicine Specialities Hospital National Medical Centre "Siglo XXI" Mexican Social Security Institute Distrito Federal 06720 México

Intestinal pseudo-obstruction secondary to systemic lupus erythematosus(SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.

关键词： Intestinal pseudo-obstruction Systemic lupus eryth

Abnormal layering of muscularis propria as a cause of chronic intestinal pseudo-obstruction:A case report and literature review

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World Journal of Gastroenterology 2015年第22期21卷 7059-7064页

作者： Napat Angkathunyakul Suporn Treepongkaruna Sani Molagool Nichanan Ruangwattanapaisarn Department of Pathology Ramathibodi Hospital Mahidol University Department of Pediatrics Ramathibodi Hospital Mahidol University Department of Surgery Ramathibodi HospitalMahidol University Department of Diagnostic and Therapeutic Radiology Ramathibodi Hospital Mahidol University

Visceral myopathy is one of the causes of chronic intestinal pseudo-obstruction. Most cases pathologically reveal degenerative changes of myocytes or muscularis propia atrophy and fibrosis. Abnormal layering of muscularis propria is extremely rare. We report a case of a 9-mo-old Thai male baby who presented with chronic intestinal pseudo-obstruction. Histologic findings showed abnormal layering of small intestinal muscularis propria with an additional oblique layer and aberrant muscularization in serosa. The patient also had a short small bowel without malrotation, brachydactyly,and absence of the 2nd to 4th middle phalanges of both hands. The patient was treated with cisapride and combined parenteral and enteral nutritional support.He had gradual clinical improvement and gained body weight. Subsequently, the parenteral nutrition was discontinued. The previously reported cases are reviewed and discussed.

关键词： Abnormal layering of muscularis propria Brachydactyly Chronic intestinal pseudo-obstruction Serosal mu

Intestinal pseudo-obstruction in inactive systemic lupus erythematosus: An unusual finding

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2010年第6期1卷 135-136页

作者： Giulia Leonardi Nicola de Bortoli Massimo Bellini Maria Gloria Mumolo Francesco Costa Angelo Ricchiuti Stefano Bombardieri Santino Marchi Gastroenterology Unit Cisanello Hospital University of Pisa Reumatology Unit Hospital of Santa Chiara University of Pisa

Chronic intestinal pseudo-obstruction (CIP) is an infre-quent complication of an active systemic lupus erythema-tosus (SLE). We illustrate a case of SLE inactive-related CIP. A 51-year old female with inactive SLE (ECLAM score 2) was hospitalized with postprandial fullness, vomiting, abdominal bloating and abdominal pain. She had had no bowel movements for five days. Plain abdominal X-ray revealed multiple fluid levels and dilated small and large bowel loops with air-fluid levels. Intestinal contrast radiology detected dilated loops. CIP was diagnosed. The patient was treated with prokinetics, octreotide, claritromycin, rifaximin, azathioprine and tegaserod without any clinical improvement. Then methylprednisolone (500 mg iv daily) was started. After the first administration, the patient showed peristaltic movements. A bowel movement was reported after the second administration. A plain abdominal X-ray revealed no air-fluid levels. Steroid therapy was slowly reduced with complete resolution of the symptoms. The patient is still in a good clinical condition. SLE-related CIP is generally reported as a complication of an active disease. In our case, CIP was the only clinical demonstration of the SLE.

关键词： Chronic intestinal pseudo-obstruction Systemic lupus erythematosus

Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment

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World Journal of Gastroenterology 2019年第31期25卷 4414-4426页

作者： Luísa Leite Barros Alberto Queiroz Farias Ali Rezaie Department of Gastroenterology University of Sao Paulo School of MedicineSao Paulo 05403-000Brazil Division of Gastroenterology Department of MedicineCedars Sinai Medical CenterLos AngelesCA 90048United States

Inflammatory bowel diseases(IBD),Crohns disease and ulcerative colitis,are chronic conditions associated with high morbidity and healthcare costs.The natural history of IBD is variable and marked by alternating periods of flare and remission.Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing,a great proportion of IBD patients remain symptomatic despite effective control of inflammation.These symptoms may include but not limited to abdominal pain,dyspepsia,diarrhea,urgency,fecal incontinence,constipation or bloating.In this setting,commonly there is an overlap with gastrointestinal(GI)motility and absorptive disorders.Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment.Therefore,in this review we describe the prevalence,diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.

关键词： Inflammatory bowel diseases Crohn’s disease Ulcerative colitis Gastrointestinal motility and absorptive disorders Irritable bowel syndrome Small intestinal bacterial overgrowth Small intestinal fungal overgrowth Dyssynergic defecation Fecal incontinence Chronic intestinal pseudo-obstruction

表现为长期影像学气腹和假性梗阻的空肠憩室一例报道

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Gastroenterology Report 2016年第4期4卷 337-340,I0003页

作者： Carolyn Hanna John Mullinax Mark S Friedman Julian Sanchez USF Morsani College of Medicine TampaFLUSA Department of Surgical Oncology Moffitt Cancer CenterTampaFLUSA

Small bowel diverticulosis is a rare finding within the general population and jejunal diverticulosis,specifically,is even rarer.Clinical manifestations can range from post-prandial pain,constipation and malabsorption to serious complications,such as gastro-intestinal hemorrhage,perforation and acute intestinal obstruction.Here we describe the case of an 81-yearold gentleman who presented with a three-year history of abdominal pain and weight loss.Despite unremarkable physical examination and laboratory tests,persistent pneumoperitoneum and dilated loops of small bowel were found on imaging.Having been given a diagnosis of small bowel bacterial overgrowth,the patient underwent capsule endoscopy study for further evaluation of his small bowel.The capsule did not reach the colon and the patient never noted passing the capsule in his stool so,six months post-procedure,a computed tomography(CT)scan seemed to reveal the retained capsule.Subsequent exploratory laparotomy revealed 200 cm of atonic,dilated jejunum with impressive diverticula along the antimesenteric border.This case report is an example of an unusual set of presenting signs and symptoms of jejunal diverticulosis,including persistent pneumoperitoneum,pseudo-obstruction and small bowel bacterial overgrowth.A literature review has revealed that these signs have been present in other cases of jejunal diverticulosis,although the etiology and pathophysiology is not clearly understood.

关键词： Jejunal diverticulosis pneumoperitoneum pseudo-obstruction

Adrenal insufficiency and bowel obstruction: An overlooked association

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Case Reports in Clinical Medicine 2013年第2期2卷 111-114页

作者： Ryan A. Kunjal Ria R. Ramadoo Surujpal Teelucksingh Vijay Naraynsingh Department of Clinical Medical Sciences University of the West Indies St. Augustine Trinidad and Tobago Department of Clinical Surgical Sciences University of the West Indies St. Augustine Trinidad and Tobago

Bowel obstruction is a documented but rare presentation of adrenal insufficiency (AI). We report a case of acute AI manifesting as intestinal pseudo-obstruction (IPO) in a patient with underlying iatrogenic adrenal suppression. An 83 years old female was admitted for partial small bowel obstruction that failed to resolve with conservative management. She then underwent exploratory laparotomy where no mechanical obstruction was found and the small bowel was manually decompressed. Postoperatively she developed acute swelling of her right ankle which was similar to mono-articular attacks in the past. This was diagnosed clinically as gout. Her obstruction failed to settle and a second laparotomy was done which yielded the same as the first. Given her past account of arthritic pain, direct questioning of steroid use unearthed a history of multiple intra-articular corticosteroid injections for analgesia. She also described several short courses of high dose oral steroids for respiratory tract infections, including a recent course which was abruptly stopped two days prior to presentation. Clinical suspicion of AI was supported by biochemical testing of stress cortisol levels and change in the serum cortisol in response to 250 μg of synthetic adrenocorticotropic hormone. Moreover, her improvement following a therapeutic trial of steroid replacement was dramatic and strongly supports this diagnosis. It is therefore worthwhile to consider a diagnosis of AI in cases of bowel obstruction in patients with comorbidities that predispose to steroid use and especially in settings where steroid abuse is prevalent.

关键词： pseudo-obstruction Steroids Adrenal Insufficiency