Nature clinical practice. Gastroenterology & hepatology · 2008
A case of chronic intestinal pseudo-obstruction secondary to primary visceral myopathy.
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Shim Lisa S E, Eslick Guy D, Kan Alex E, Kalantar Jamshid S
Аннотация
BACKGROUND: A 13-year-old girl presented to the emergency room at her local hospital with an acute onset of vomiting, severe abdominal pain and distension. There was evidence of small-bowel obstruction on plain abdominal x-ray. Throughout the girl's adolescent years she was admitted to hospital numerous times for recurrent abdominal symptoms and underwent multiple sequential laparotomies. She had marked weight loss and a poor quality of life. The patient's symptoms were initially managed with intravenous fluids, bowel rest, and nasogastric decompression of the upper gut.
INVESTIGATIONS: Peripheral blood tests with biochemistry and measurement of serum folate, vitamin B(12), albumin, 25-hydroxyvitamin D, inflammatory markers, autoantibodies and thyroid function; gastrointestinal imaging (plain abdominal x-ray, small-bowel series, colonic transit study, and abdominal CT with oral contrast); MRI of the brain and lumbar puncture; upper endoscopy; and laparotomy with sero-muscular biopsy of the small bowel.
DIAGNOSIS: Chronic intestinal pseudo-obstruction secondary to primary visceral myopathy.
MANAGEMENT: Prokinetic agents including oral cisapride and tegaserod, a venting gastrostomy, and total parenteral feeding.
INVESTIGATIONS: Peripheral blood tests with biochemistry and measurement of serum folate, vitamin B(12), albumin, 25-hydroxyvitamin D, inflammatory markers, autoantibodies and thyroid function; gastrointestinal imaging (plain abdominal x-ray, small-bowel series, colonic transit study, and abdominal CT with oral contrast); MRI of the brain and lumbar puncture; upper endoscopy; and laparotomy with sero-muscular biopsy of the small bowel.
DIAGNOSIS: Chronic intestinal pseudo-obstruction secondary to primary visceral myopathy.
MANAGEMENT: Prokinetic agents including oral cisapride and tegaserod, a venting gastrostomy, and total parenteral feeding.