Treatment of end stage chronic intestinal pseudoobstruction by subtotal enterectomy and home parenteral nutrition

Abstract

Three cases are described of end stage chronic intestinal pseudo-obstruction successfully treated by subtotal enterectomy and home parenteral nutrition (HPN). In all three patients prior use of drugs to stimulate gastrointestinal motility, antibiotics to suppress bacterial overgrowth and surgical bypass of dilated bowel had failed to alleviate the symptoms of chronic intestinal obstruction. Similarly parenteral nutrition combined with restriction of oral intake, although improving nutrition did not relieve symptoms. The treatment of end stage chronic pseudoobstruction should relieve intestinal obstruction and correct nutritional deficiency. In our experience this is best achieved by subtotal enterectomy, restoration of continuity by end-to-end anastomosis and total parenteral nutrition.