Imaging Studies

Computed tomography may identify bowel wall thickening, pneumoperitoneum, or pneumatosis intestinalis, which are all potential complications of intestinal pseudo-obstruction. Barium studies (enteroclysis or upper GI with small bowel follow-through) to examine the upper GI tract, followed by barium enema, is often required to rule out mechanical obstruction and provide evidence of intestinal dilatation secondary to pseudo-obstruction. Consideration must always be given to the risk of barium impaction should complete obstruction be present. Alternatives may include water-soluble contrast or small amounts of barium with air contrast. Barium studies may also demonstrate a lack of peristalsis (myopathic processes) or chaotic peristalsis (neuropathic processes). An upper GI series may demonstrate isolated megaduode-num or wide-mouthed intestinal diverticula, commonly seen with myopathic processes such as scleroderma. Loss of haus-tral markings, a dilated colon, or a markedly dilated and redundant colon (megacolon) may be present. Endoscopic evaluation (upper endoscopy, colonoscopy, and capsule endoscopy) for masses, strictures, or physical obstruction (or lack thereof) may aid in establishing the diagnosis of CIP.

Intestinal Distension and No Transition: Pseudoobstruction

Esophageal

Manometry;

Antro-

Duodenal

Manometry

Unclear Diagnosis or No

Identifiable Cause: Exploratory Laparotomy with Full Thickness

FIGURE 63-1. Algorithm: diagnosis of chronic intestinal pseudoobstruction. CBC = complete blood cell, CT = computed tomography, UGI = upper gastrointestinal series.

Mechanical Obstruction: Decompress and Surgery

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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