CHRONIC PSEUDO-OBSTRUCTION OF THE SIGMOID COLON: A CASE REPORT/KRONICNA PSEUDO-OPSTRUKCIJA SIGMOIDNOG KOLONA - PRIKAZ SLUCAJA

• Published in: Acta clinica Croatica (Tisak) Vol. 61; no. 4; p. 735
• Main Authors: Vulic, Ivan, Sestan-Pesa, Matija, Misic, Dubravka Muzina, Pavic, Ivana, Zivkovic, Mario, Budimir, Ivan, Hrabar, Davor, Ljubicic, Neven, Nikolic, Marko
• Format: Journal Article
• Language: English
• Published: Klinicki bolnicki centar Sestre milosrdnice 01.12.2022
• Subjects: Croatia
• ISSN: 0353-9466
• DOI: 10.20471/acc.2022.61.04.23

Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by signs of intestinal obstruction lasting for 6 months or more, in the absence of a definitive cause of obstruction. We report a case of CIPO in a 49-year-old female patient with a 6-month history of ongoing irregular bowel movements, manifested as constipation and diarrhea accompanied by abdominal pain and bloated feeling. Contrast-enhanced abdominal computed tomography and magnetic resonance enterography revealed focal thickening of a segment of the lienal flexure and intermittent areas of wider and narrower caliber along the sigmoid colon. No signs of a definitive cause of obstruction were found, but evidence for dolichosigma was revealed, which was later confirmed with colonoscopy. Due to persisting symptoms, the patient agreed to elective resection of the sigmoid colon. Following the procedure, symptoms regressed with a significant improvement in the quality of life. The patient has been regularly monitored in an outpatient setting and reports absence of the symptoms since the procedure. Pathophysiology of the resected section revealed more prominent lymphatic tissue, follicular arrangement, and reactively altered germinal centers, which can suggest CIPO. Key words: Chronic intestinal pseudo-obstruction; Dolichosigma; Constipation; Abdominal pain; Abdominal computed tomography; Abdominal magnetic resonance enterography Kronicna intestinalna pseudo-opstrukcija (KIPO) je vrlo rijedak sindrom obilje?en znakovima intestinalne opstrukcije koji traju 6 mjeseci ili du?e, a u odsutnosti definitivnog jasnog uzroka. U na?em prikazu slucaja radi se o 49-godi?njoj bolesnici koja je vi?e od 6 mjeseci imala stalne nepravilne stolice koje su se manifestirale izmjenom proljeva i konstipacije, a bile su pracene naduto?cu i bolovima u trbuhu. Ucinjenom obradom koja je ukljucivala kontrastnu kompjutoriziranu tomografiju i magnetsku enterografiju kod bolesnice je utvrdeno ?ari?no zadebljanje segmenta lienalne fleksure i isprekidana podrucja ?ireg i u?eg kalibra du? sigmoidnog kolona. Nije naden jasni uzrok opstrukcije, ali je otkrivena anatomska varijanta dolihosigme koja je kasnije potvrdena i kolonoskopijom. Zbog vrlo izra?enih dugotrajnih simptoma koji nisu regredirali na konzervativne metode lijecenja bolesnica je pristala na preporucenu elektivnu resekciju sigmoidnog kolona. Nakon zahvata simptomi su se povukli uz znacajno pobolj?anje kvalitete ?ivota, a bolesnica se redovito prati u gastroenterolo?koj ambulanti. Patohistolo?ki nalaz reseciranog dijela sigmoidnog kolona otkrio je istaknutije limfno tkivo, folikularni raspored i reaktivno promijenjene germinativne centre, ?to ide u prilog dijagnoze KIPO-a. Kljucne rijeci: Kronicna intestinalna pseudo-opstrukcija; Dolihosigma; Konstipacija; Bol u trbuhu; CT abdomena; MR abdomena; Elektivna resekcija sigmoidnog kolona