Colon non tumor
Congenital anomalies
Chronic intestinal pseudo-obstruction

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 13 December 2016, last major update May 2013

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Colon[title]Chronic intestinal pseudo-obstruction
Cite this page: Chronic intestinal pseudo-obstruction. PathologyOutlines.com website. http://pathologyoutlines.com/topic/colonchronicintest.html. Accessed October 20th, 2017.
Definition / general
  • Syndrome of intestinal obstruction without mechanical obstruction
  • Usually a small bowel disorder but can occur anywhere in GI tract
  • Ogilvie's syndrome (acute colonic pseudo-obstruction): abrupt onset of abdominal distension (Radiol Med (Torino) 2005;109:370)
Etiology
  • Gut motility depends on sympathetic (thoracolumbar) and parasympathetic (vagal) innervation to ganglionated plexi; also enteric nervous system, smooth muscle cells and interstitial cells of Cajal
  • Results from autonomic imbalance resulting in sympathetic overactivity affecting some part of colon (Singapore Med J 2009;50:237)
  • Usually congenital in children; in adults due to systemic disease (amyloidosis, Chagas disease, dermato/polymyositis, diabetes, muscular dystrophy, myotonic dystrophy, myxedema, scleroderma), drugs (antiParkinson, clonidine, ganglionic blockers, phenothiazines, tricyclic antidepressants) or idiopathic (cathartic colon, ceroidosis, Hirschsprung's disease, visceral myopathies, visceral neuropathies)
  • May be due to loss of interstitial cells of Cajal in small and large bowel (Am J Surg Pathol 2003;27:228)
Prognostic factors
Case reports
Treatment
  • Diet, octreotide, surgery, transplant
Microscopic (histologic) description
  • Visceral myopathy: vacuolar degeneration with swelling and loss of muscle cells, fibrosis of outer longitudinal muscle layer; other cases show cytoplasmic vacuoles, marked nuclear enlargement and irregularity and interstitial fibrosis (Am J Surg Pathol 1987;11:846)
  • May have segmental hypoganglionosis at transitional zone (Am Surg 2011;77:736)
Microscopic (histologic) images
Familial autonomic visceral myopathy:

Figure 1

Figure 2

Figure 3


Fig 1: muscularis propria degeneration-especially inner layer
Fig 2: muscularis propria degeneration-with muscle fiber loss and degenerative changes and collagen replacement
Fig 3: muscularis mucosa shows degenerative changes of fibers (vacuolation and pyknotic nuclei)
Differential diagnosis
  • Ischemic colitis: hemosiderin deposits, fibrous stricture
  • Scleroderma: patchy bowel involvement, dense fibrosis affecting inner or all muscle layers, no vacuolar change
  • Tuberculosis: stricture, necrotizing granulomas