Presentation
The patient was referred to perform a barium follow-through study. Complaint: abdominal distension and intestinal fullness, sensation of food trapped in the upper abdomen, and vomiting. Surgical history: the patient presented three times before with a picture of intestinal obstruction, in which surgery was done.
Patient Data
Plain Film shows distended stomach and bowel loops.
After ingestion of Barium, there is an Initial arrest of the contrast at the level of the duodenum and minimal passage beyond that level. The stomach and duodenum show distension and redundancy, as well as a soup dish appearance. Very little contrast reached distal ileal loops after 90 minutes, which remained stagnant in a dilated bowel loop at the pelvis for a period of more than 5 hours.
Case Discussion
Picture suggestive of a motility disorder, later confirmed by pathology as a case of primary myopathic chronic intestinal pseudo-obstruction.
Intestinal pseudo-obstruction is characterized by the dilation of the bowel in the absence of an anatomical obstruction. Patients present with signs and symptoms of bowel obstruction, including nausea, vomiting, abdominal distension, and obstipation, with bowel dilation on X-ray or CT imaging. Pseudo-obstruction can be acute or chronic. The exact pathophysiology is unknown, but it has been linked to dysregulation of the autonomic nervous system 1.
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