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Chronic intestinal pseudo-obstruction due to adult-onset acquired isolated hypoganglionosis with muscular atrophy in the small intestine: a case report and review of literature

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Abstract

Background

Chronic intestinal pseudo-obstruction (CIPO) is a rare intestinal disorder characterized by impaired propulsion of the digestive tract and associated with symptoms of intestinal obstruction, despite the absence of obstructive lesions. CIPO includes several diseases. However, definitive diagnosis of its etiology is difficult only with symptoms or imaging findings.

Case presentation

A 56-year-old man was referred to our hospital due to a 3-year history of continuous abdominal distention. Imaging, including computed tomography of the abdomen, and endoscopy revealed marked dilatation of the entire small intestine without any obstruction point. Therefore, he was diagnosed with CIPO. Since medical therapy didn’t improve his symptoms, enterostomy and percutaneous endoscopic gastro-jejunostomy were performed. These procedures improved abdominal symptoms. However, he required home central venous nutrition due to dehydration. The pathological findings of full-thickness biopsies of the small intestine taken during surgery revealed decreased number and degeneration of ganglion cells in the normal plexus. These findings led to a final diagnosis of CIPO due to acquired isolated hypoganglionosis (AIHG).

Conclusions

Here, we report the case of a patient with CIPO secondary to adult-onset AIHG of the small intestine. Since AIHG cannot be solely diagnosed using clinical findings, biopsy is important for its diagnosis.

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Acknowledgements

We thank Dr. Dr. Atsushi Nakajima, Dr. Takaomi Kessoku and Dr. Hidenori Ohkubo for their clinical recommendations.

Funding

This work was supported by JSPS KAKENHI Grant Number 23K15014.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan

    Sayoko Tayama, Yoki Furuta, Miyuki Morito, Hideaki Naoe & Yasuhito Tanaka

  2. Department of Diagnostic Pathology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan

    Daiki Yoshii

  3. Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-City, Fukuoka, 812-8582, Japan

    Yasuyuki Uchida, Koichiro Yoshimaru & Tomoaki Taguchi

  4. Department of Gastroenterological Surgery, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan

    Yuji Miyamoto

  5. Fukuoka College of Health Sciences, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan

    Tomoaki Taguchi

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  1. Sayoko Tayama
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Correspondence to Yasuhito Tanaka.

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Supplementary file1 Magnetic resonance enterography (MRE). Cine images showed reduced peristaltic movements of certain parts of the small intestine, especially in the distal ileum, indicating decreased contractility (MPG 7938 KB)

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Tayama, S., Furuta, Y., Morito, M. et al. Chronic intestinal pseudo-obstruction due to adult-onset acquired isolated hypoganglionosis with muscular atrophy in the small intestine: a case report and review of literature. Clin J Gastroenterol 17, 244–252 (2024). https://doi.org/10.1007/s12328-023-01902-x

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