Colonic pseudo obstruction: a new complication of jejunoileal bypass

Abstract

5 Female patients ranging in age from 25 to 44 yr are reported in whom jejunoileal bypass (3 end to side and 2 end to end) performed for morbid obesity, was complicated 1 1/2 to 3 yr later by symptoms of colonic pseudo obstruction. In each case, the colon was markedly elongated, dilated, and atonic but with no demonstrable organic obstruction. The cause of this complication is not known. Full thickness rectal biopsy in 1 case showed normal intrinsic nervous plexuses and ganglia. Serum electrolytes were normal. Functional and defunctionalized small bowel were not involved. Symptoms varied from complete colonic paralysis to incapacitating crampy abdominal pain and distention. In the 3 patients with end to side bypass, dilatation affected the entire colon, while, in the 2 patients with end to end bypass, the dilatation was localized to colon distal to the anastomosis with the defunctionalized small bowel. Resection of the affected portion of colon in one case resulted in recurrence distal to the new site of drainage of defunctioned bowel. Treatment with anti anaerobe antibiotics in 2 cases produced dramatic but temporary relief of symptoms.