The article describes two cases of chronic intestinal pseudo-obstruction (CIPO). This rare intestinal motility disease is associated with high morbidity and mortality. The obstruction is functional, without any radiologically or surgically detectable obstacle, in contrast to volvulus that is a purely mechanical obstruction. Symptoms are recurrent and evolve over several months or years. Based on a literature review, we here present a coherent pluridisciplinary approach used to optimize the diagnosis and treatment necessary to help an elderly multimorbid and often polymedicated population. Since CIPO is an incurable disease, the main therapeutic objectives are the control of symptoms and ionic disorders, enteral nutrition, and maintenance of mobility.
Key Words
Chronic intestinal pseudo-obstruction (CIPO), volvulus, chronic constipation, elderly
What is already known about the topic?
- CIPO is a rare and little-known disease occurring at any age.
- Its prevalence is unknown, and the disease has rarely been described in elderly patients.
- Morbidity and mortality are high.
- There is no curative treatment.
What does this article bring up for us?
- There are probably CIPO cases hidden behind the frequent cases of chronic constipation in elderly patients.
- Four criteria must be present for diagnosis: at least one episode of intestinal obstruction over the last 6 months, bloating and/or abdominal pain over the last 12 weeks, dilation and/or intestinal hydro-aerial levels at imaging, and absence of organic disease.
- Each diagnostic assessment of CIPO should be well thought and adapted to the profile of the geriatric patient.
- The control of symptoms and ionic disorders (potassium may be a cause or a consequence, with an original mechanism of potassium hypersecretion in diarrhea), enteral nutrition, and maintenance of a minimal mobility are of paramount importance.