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The surgeon's role in the treatment of chronic intestinal pseudoobstruction
M M Murr1, M G Sarr, M Camilleri
1Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Objective:
The surgeon's role in the treatment of patients with chronic intestinal pseudoobstruction (CIP) is under-appreciated. Our aim was to determine the effects of operative treatment on symptomatic relief of CIP.
Methods:
Records of all 21 patients who underwent surgery for CIP from 1980 to 1990 were reviewed. CIP was diagnosed by a combination of manometric, radiological, and/or histological examinations.
Results:
Six of the nine patients who underwent resection or bypass of presumably localized disease are currently maintained on oral intake; one patient with multiple sclerosis who cannot eat is fed via a gastrostomy tube. Enterostomy tube(s) were placed in the other 12 patients; four no longer use the enterostomy tube(s), and eight rely on these decompressive tube enterostomies for symptomatic relief. After operative treatment, hospital readmissions decreased from a mean of 0.5 to 0.1 admission/year. All 19 patients currently alive report improved quality of life.
Conclusions:
Selective and directed operative treatment of patients with CIP can result in therapeutic and palliative benefits. The surgeon should have an active role in the evaluation and possible treatment of patients with CIP.