Intestinal pseudo‐obstruction in patient affected by multiple sclerosis: case report

A 64-year-old woman affected by multiple sclerosis withbladder dysfunction and severe disability was admitted toour hospital with painless abdominal distension, contin-uous vomiting and absence of defecation for 3 days. Shereported a 3 years history of constipation. Abdominal X-ray and CT scan showed multiple fluid levels, distendedloops of small bowel and dilatation of the entire colon. Adiagnosis of pseudo obstruction was suspected. After24 h of conservative therapy, there was no improvementand her general condition worsened. An emergencylaparotomy that showed this gross distension of all thebowel to the mid jejunum without incidence of mechan-ical obstruction was performed (Fig. 1). A sigmoid loopcolostomy was performed. Bowel function took place onthe second post-operative day. During hospitalization,the patient underwent a colonoscopy which was normal,and ano-rectal manometry, which showed a reduction ofrectal sensitivity and compliance. Bladder manometry wasabnormal. Restoration of sigmoid colon continuity wasperformed at 2 months from surgery and the patients hada normal bowel function at 8 months later.