Chronic intestinal pseudo-obstruction when surgical decompression and resection did not achieve its goals

Chronic intestinal pseudo-obstruction (CIPO) requires a stepwise approach. When an initial course of surgical management does not produce the expected clinical improvement, a defined next-line strategy is available.

Prior treatment and failure condition

This protocol applies after surgical decompression and resection — including gastrostomy, jejunostomy, loop enterostomy, or resection of localised segments of impaired motility — failed to achieve: reduced abdominal distension, reduced vomiting, and improved tolerance of enteral feedings.

Clinical goals of this protocol

The primary therapeutic target at this stage is improvement in nausea and vomiting.

Treatment approach — partial overview

The next-line approach turns to device-based and investigational interventions that act on specific anatomical targets and the neuromuscular function of the gut. The complete set of options, clinical criteria, and decision sequence is available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1053/j.gastro.2005.06.081

A fascinating and promising therapeutic approach to CIPO involves the use of gastric and intestinal pacemakers.

The use of the pacemaker has been associated with significant improvement in nausea and vomiting.

The use of botulinum toxin injection in the pylorus and anus has been used to improve transit through those sphincters.

Hyperbaric oxygenation has been reported to be beneficial in a child with myopathic CIPO who had presented with abdominal distension and obstructive symptoms.

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