ADULT CHRONIC IDIOPATHIC PSEUDO-ILEUS OF THE LARGE INTESTINE -A REPORT OF AN OPERATED CASE-

A recently operated case of chronic idiopathic pneudo-ileus in an adult is reported with some bibliographical comments. A 27-year-old man who had had no abnormal bowel movements in his childhood had been taking cathartics for constipation and abdominal distention for these 15 years. And the patients was seen at the hospital because constipation was aggravated and his bowel movements became once a month. On admission the abdomen remarkably distended and abdominal x-ray film and CT revealed the dilated sigmoid colon with the diameter to 22cm and a large quantity of coprostasis. Barium enema study revealed no narrow segment in the rectum and a colonoscopic fiber visualized an infant's head sized coprolith. Rectal biopsy demonstrated the presence of ganglion cells. From these findings, the diagnosis of chronic idiopathic pseudo-ileus of the large intestine was made and an operation was performed. Upon laparotomy, a significant dilatation of the colon with maximum diameter of 35cm extending about 50cm in length from the turning point of peritoneum to descending colon was confirmed. An excision of the intestine by 50cm starting at 5cm oral side from the peritoneal turning point was performed, with an end-to-end anastomosis. Histo-pathologically, a mild degeneration in ganglion cells was noted. Postoperative course was uneventful. As of 1.5 years after the operation, he has bowel movements on an once-a day basis and the abdominal distention disappeared.