Chronic Intestinal Pseudo-obstraction Associated with Systemic Sclerosis Induced by Surgical Stress—A Case Report

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 80; no. 9; pp. 1665 - 1669
• Main Authors: KOHARA, Yuichiro, KATSURA, Hikotaro, TANIGAWA, Yuma, KUMODE, Wataru, HIGASHIYAMA, Hiroshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2019
• Subjects: chronic intestinal pseudo-obstruction; paralytic ileus; systemic sclerosis
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.80.1665

Complications of systemic sclerosis (SSc) include chronic intestinal pseudo-obstruction (CIP). When a patient has only a subtle skin lesion of SSc, it is very difficult to diagnose SSc that underlies CIP. We report a case of CIP associated with SSc induced by surgical stress, in which differentiation from postoperative paralytic ileus was so difficult.A 71-year-old woman was admitted for adhesive small bowel obstruction. Although she responded to the conservative treatment, she underwent operation because of immediate recurrence after discharge. She underwent re-operation for suspected re-obstruction at the same location as before the 1st operation. After the 2nd operation, given the refractory paralytic ileus persisted, we searched underlying disease for suspected CIP. The findings of skin hardening that was localized in only the fingertips, Raynaud phenomenon, and positive anti-centromere antibody led to diagnose SSc. We then diagnosed the case as CIP with SSc because paralytic ileus had continued for more than 6 months after the operation. Surgical stress may induce CIP associated with SSc. The findings of skin hardening that was localized in only the fingertips and Raynaud phenomenon served to diagnose CIP associated with SSc.