Chronic intestinal pseudo-obstruction in adult patients: multidetector row helical CT features

Chronic intestinal pseudo-obstruction (CIPO) is a rare condition due to severe gastrointestinal motility disorder. Adult patients with CIPO experience symptoms of mechanical obstruction, but reliable clinical signs that may help distinguish between actual mechanical obstruction and CIPO are lacking. Additionally, abdominal plain films that commonly show bowel dilatation with air-fluid levels do not reach acceptable degrees of specificity to exclude actual obstruction. Therefore, most adult patients with CIPO usually undergo multiple and often fruitless surgery, often leading to repeated bowel resections before diagnosis is made. In these patients who present with abdominal signs mimicking symptoms that would warrant surgical exploration, multidetector-row helical CT (MDCT) is helpful to resolve this diagnostic dilemma. MDCT shows a diffusely distended bowel and helps to rule out a mechanical cause of obstruction, thus suggesting CIPO and obviating the need for unnecessary laparotomy. In adult patients with CIPO, MDCT may show pneumatosis intestinalis, pneumoperitoneum or intussusception. However, these conditions generally do not require surgery in patients with CIPO. This pictorial essay presents the more and less common MDCT features of CIPO in adult patients, to make the reader more familiar with this disease.