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Challenges in management and prognosis of pediatric intestinal pseudo-obstruction
Özlem Boybeyi Türer1, Tutku Soyer1, Hasan Özen2
1Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey.
Insights
Pediatric intestinal pseudo-obstruction (PIPO) is a severe pediatric intestinal dysmotility. Diagnosis and treatment are challenging, but prognosis improves with fewer operations and identification of secondary causes.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Motility Disorders
- Dysautonomia
Background:
- Pediatric intestinal pseudo-obstruction (PIPO) represents the most severe form of intestinal dysmotility in children.
- Accurate diagnosis and effective management remain significant challenges in PIPO cases.
Purpose of the Study:
- To present a series of PIPO cases.
- To discuss the diagnostic approaches, management strategies, and prognostic factors associated with PIPO.
Main Methods:
- Retrospective analysis of medical records for patients diagnosed with PIPO between 2010 and 2018.
- Inclusion of 7 pediatric patients with PIPO.
Main Results:
- Common symptoms included abdominal distention and constipation.
- Diagnostic findings included slow gastrointestinal transit and malrotation in some patients.
- Prognosis was significantly better with fewer surgical interventions (p=0.029) and improved when secondary causes were identified.
Conclusions:
- PIPO is a complex group of diseases requiring careful diagnosis and treatment.
- Ruling out secondary causes is crucial for effective management.
- Multimodal treatment approaches aim to optimize nutrition, prevent sepsis, and restore intestinal motility, with prognosis linked to identified secondary causes and surgical history.
Background/Aims:
Pediatric intestinal pseudo-obstruction (PIPO) is the most severe form of intestinal dysmotility in children. This study aims to present the cases of PIPO to discuss its diagnosis, management, and prognosis.
Materials And Methods:
We retrospectively analyzed the medical records of the patients with PIPO between 2010 and 2018.
Results:
A total of 7 patients were included. The admission age was 3 days-10 years. The complaints were abdominal distention and constipation in all the patients. All the patients had passed meconium in the first 48 hours of their life. An upper gastrointestinal (GI) series revealed slow transit in 6 patients and malrotation in 2 patients. Full-thickness rectum biopsies revealed normal ganglion cells. Neurological examination revealed postinfectious pandysautonomy in 1 patient. Furthermore, 2 patients are under follow-up with ileostomy and TPN, 1 patient is with enteral feeding and ileostomy, and 3 patients are stable with pyridostigmine, enemas. Moreover, 1 patient died because of sepsis. The prognosis was not significantly correlated with initial presentation time, lag time, and presence of extraintestinal manifestations (p>0.05). The prognosis was significantly better when fewer number of operations were performed (p=0.029) Conclusion: PIPO is a broad-spectrum disease group that is difficult to diagnose and treat. It is mandatory to rule out the secondary causes of diagnosis. Medical and surgical treatments are used to support the nutritional status, prevent sepsis, and restore the intestinal motility. The prognosis was better when the secondary causes were identified and fewer operations were performed.
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