Successful Surgery for Intestinal Pseudo-Obstruction with Progress Systemic Sclerosis: Report of a Case

Makoto Yoshida, Takanori Tabo, Hideki Hayashi and Hisashi Onodera*

Department of Surgery, Hayashi General Hospital
Department of Surgery and Surgical Basic Science, Kyoto University Graduate School of Medicine*

We report a case of pseudo-obstruction associated with progress systemic sclerosis (PSS) successfully managed by resection of the affected ileum. A 74-year-old-woman with PSS admitted for abdominal fullness and vomiting had a history of frequent abdominal pain and distension in the last 5 years. Plain abdominal X-ray showed marked intestinal gas with air-fluid, indicating small intestinal ileus, but no significant findings were seen in colonoscopy. Small bowel examination by contrast media imaging confirmed localized absence of peristalsis at the terminal ileum and no organic abnormalities. Initially the patient was treated by medication and discharged 1 month later. After abdominal symptoms reappeared soon after, we decided to operate because the pseudo-obstruction was limited to the terminal ileum, conducting partial resection of the thickened ileum. The patient was discharged 37 days later with normal bowel function. A resected specimen of the ileum showed marked atrophy of the muscularis propria and deposition of collagen in the submucosal layer. Although pseudo-obstruction is intractable and usually treated by medication, patients may require long-term intravenous hyperalimentation. This particular case report presents a possible surgical indication in which the disease is limited to a small part of the bowel.

Key words
intestinal pseudo-obstruction, progressive systemic sclerosis

Reprint requests
Makoto Yoshida Department of Surgery, Hayashi General, Hospital
1-5-7 Fuchu, Takefu-City, 915-8511 JAPAN

Accepted
December 19, 2003

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