thi ppt disscuss points about Acute, chronic and paediatric intestinal-pseudo obstructions are rare disorders that occur when nerve or muscle problems slow or stop the movement of food, fluid, air, and waste. Symptoms of intestinal pseudo-obstruction include abdominal pain, bloating, and nausea and vomiting. Diagnosis is based on clinical observation and radiography. Treatment involves medications, specialized diets, nutritional support, surgery, and physical therapy. The pathophysiology of Chronic intestinal pseudo-obstruction is multifactorial and assigned to several theories, Theory of autonomic denervation, the Hormonal Theory and the Pharmacologic Theory

1. intestinal-pseudo
obstruction
By Roba Mosa

2. CONTENTS
01 02 03
Introduction Acute intestinal-
pseudo obstruction
Chronic intestinal-
pseudo obstruction
Paediatric intestinal-
pseudo obstruction Conclusion
06
04 05
Discussion

3. Introduction
● Intestinal pseudo-obstruction (IPO) is a rare clinical syndrome characterized by
bowel dilation in the absence of any actual obstruction in the intestine.
● IPO can result from myogenic or neurogenic causes.
● Impaired intestinal peristalsis leads to the buildup of digested food in the intestine,
which can cause symptoms that mimic obstruction, including abdominal pain,
severe nausea, vomiting, and bloating.
● There are two types of IPO: chronic and acute.
● It is important to differentiate between intestinal IPO and gastroparesis, which
resembles IPO but involves an actual obstruction in the intestine.
Student: Mosa Abu Dawwas

4. Acute intestinal-pseudo
obstruction
• Acute colonic pseudo-obstruction
is a rare condition that causes
sudden swelling of the colon
without any mechanical
blockages or obstructions.
• It was first identified by Sir
William Ogilvie in 1948 and for
this it is referred to as Ogilvie’s
syndrome.
• Theory of autonomic denervation:
There are some experts who believe that
the cause of Ogilvie’s syndrome is a
decrease in the parasympathetic tone,
rather than an increase in sympathetic
tone. The majority of authors suggest that
the dilation of the colon in OS is a result of
decreased activity in the parasympathetic
nervous system, specifically in the sacral
plexus (which includes S2, S3, and S4),
leading to weakness in the lower part of
BACKGROUND pathophysiology
Student:
Mohammed Kathem
Salah

5. Acute intestinal-pseudo
obstruction
• The most important
symptoms that appear on
the patient are: vomiting,
nausea, abdominal
distension and obstipation
with bowel dilation on x-ray
or CT imaging.
• Diagnosis is made based on
careful clinical observation and
simple radiography of the
abdomen, which shows
degrees of colon expansion in
terms of diameter and
detection of perforations, etc.
However, a water-soluble
enema or tomography must
be performed to distinguish
between mechanical and false
obstruction.
• Mechanical Obstructions.
• Toxic Megacolon.
• Fecal Impaction.
SYMPTOMS
DIAGNOSIS
Differential Diagnosis
Student: Shahd Ghannam

6. Chronic intestinal-pseudo
obstruction
• It's A CHRONIC intestine
motility disorder that causes
total or partial peristalsis loss,
represents as a specially
difficult clinical challenge.
• CIPO is divided into acquired, congenital and idiopathic
• Acquired CIPO is often secondary to large arrays of diseases
that affect intestinal motility through one of the following and
leads to CIPO:
 1. autonomic nervous system (stroke ,diabetes)
 2. intestinal wall muscle layer (progressive systemic sclerosis )
 3. OR mixed nervous system and intestinal wall muscle layer
(scleroderma).
• Congenital CIPO: some cases with genetic characteristics
suggest that CIPO may involve:
 1. Autosomal dominant inheritance
 2. Autosomal recessive inheritance
 3. sex chromosome-related inheritance.
BACKGROUND CLASSIFICATION
Student: Raneem Tayeh

7. Chronic intestinal-pseudo
obstruction
• Since subocclusive episodes can
occur in people who appear to be
in good health, the onset of CIPO
is typically covert, with
gastrointestinal symptoms that
come before the first acute
episode. When functional
derangement primarily affects
the upper gastrointestinal tract,
nausea, vomiting, and weight
loss predominate.
• The diagnosis of CIPO is predominantly
clinical supported by:
• Radiology :is one of the most essential test
in the CIPO diagnosis. Distended bowel
loops with air-fluid levels are typical signs of
intestinal occlusion that can be seen on plain
abdominal films.
• Endoscopy and colonoscopy: It enables the
exclusion of wrong radiologic diagnoses of
mechanical occlusion in the proximal small
bowel and duodenum. (collecting full-
thickness biopsies for examination of the
Clinical
features DIAGNOSIS
Student: Hala sholi

8. Chronic intestinal-pseudo
obstruction
In the beginning, the supportive
treatment for this disease is the
preferred management, which is
done through the mouth and
intravenous fluids .
Supportive therapy
neostigmine is used by
injecting it intravenously.(mild
abdominal cramps and
excessive salivation as a side
effect .
Medical therapy
Colectomy : remove
part of colon
Surgical procedure:
Student: Hala sholi

9. Paediatric intestinal-pseudo
obstruction
• Pediatric Intestinal Pseudo-
Obstruction (PIPO) is a rare
condition in which the
intestine loses its ability to
contract and move food,
fluids, and gas through the
digestive tract. This results in
symptoms similar to those of a
mechanical bowel obstruction,
but with no physical blockage
present.
• The frequency of pediatric
intestinal pseudo-obstruction
(PIPO), an uncommon
digestive condition, is not well
known. PIPO, on the other
hand, is thought to afflict 1 in
25,000 to 50,000 live births.
• The symptoms of PIPO can
vary depending on the
severity and location of the
affected area of the
intestine. They may include
nausea, vomiting,
abdominal pain, bloating,
constipation, diarrhea,
malnutrition, and failure to
thrive.
BACKGROUND
EPIDEMIOLOGY
SYMPTOMS
Student: Wesam
daraghmeh

10. Paediatric intestinal-pseudo
obstruction
• The diagnosis of PIPO is
based on the presence of
objective measures of small
bowel neuromuscular
involvement, Investigations
involve radiology,
endoscopy, laboratory.
• The treatment of PIPO
requires a
multidisciplinary
approach and may
include restoring
hydroelectrolytic balance.
• Treatment options may
include medications,
specialized diets,
nutritional support,
surgery, and
• Pediatric intestinal pseudo-
obstruction (PIPO) presents
several challenges for
affected children, their
families, and healthcare
providers:
• Difficulty in diagnosis
• Complex management
• Impact on quality of life
• Limited research
DIAGNOSIS
TREATMENT
CHALLENGES
Student: Dana Turabi

11. DISCUSSION
• The pathophysiology of the disease is poorly understood.
• It is thought to be multifactorial and assigned to many theories, one of them we have discussed
previously, Theory Of Autonomic Denervation.
• Regarding to additional theories we’ll discuss firstly:
The Hormonal Theory; which suggests that the release of Prostaglandin E stimulates the circular
layer of the colonic wall. The second theory, Pharmacologic Theory, suggests that some drugs
such as (Neurotropic medications, opiates, and other long acting colotoxic medications) are a
causative agent of the disease. In addition to Vascular Theory that based on reduced splanchnic
perfusion (hypovolemia, mesenteric vascular disease), hypoperfusion is typically most severe at the
border between the superior and inferior mesenteric arterial circulation, ( Zone of Griffiths), which
corresponds to the typical cut-off near the splenic flexure.

12. DISCUSSION
• According to treatment, as we mentioned previously, for Chronic intestinal pseudo- obstruction we
can use Neostigmine as a drug of choice. However, in some cases the pharmacological approach
isn’t successful or contraindicated, colonoscopic decompression is considerable treatment, by
placing a decompression tube in the transverse colon. If the later also failed, surgery is the final
option by placing cecostomy tube or performing a colectomy.
We can also utilize intestinal motility stimulants, such as Erythromycin, a gastro-intestinal irritant and
motility stimulant, although it is not advised in current practice because its stated success rate is just
40%, with a recurrence rate reaching 50%.

13. CONCLUSION
• Acute, chronic and paediatric intestinal-pseudo obstructions are rare disorders that occur when
nerve or muscle problems slow or stop the movement of food, fluid, air, and waste.
• Symptoms of intestinal pseudo-obstruction include abdominal pain, bloating, and nausea and
vomiting.
• Diagnosis is based on clinical observation and radiography.
• Treatment involves medications, specialized diets, nutritional support, surgery, and physical
therapy.
• The pathophysiology of Chronic intestinal pseudo-obstruction is multifactorial and assigned to
several theories, Theory of autonomic denervation, the Hormonal Theory and the Pharmacologic
Theory

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