Ultrasound Pictures“Pseudo-Obstruction,”

Classification Pseudo-Obstruction :

> Chronic, intermittent, secondary (diabetes mellitus, myxedema, amyloidosis,       scleroderma, dermatomyositis, muscular dystrophy, endocrine disorders)
> Idiopathic
> Acute (Ogilvie syndrome) after a severe illness or surgical operation

Clinical manifestations Pseudo-Obstruction: intermittent pain, abdominal distention, nausea, vomiting (suggests mechanical bowel obstruction); constipation, possible intermittent diarrhea with steatorrhea (in blind pouch syndrome due to intestinal bacterial overgrowth); malnutrition ranging to anorexia

Diagnosis Pseudo-Obstruction:

x History, clinical examination: Digital rectal examination is important (rectal
ampulla is filled with stool in pseudo-obstruction, empty with a true obstruction)
x Laboratory tests, including tests for endocrine disorders
x Sonography
x Endoscopic examination and biopsy (amyloidosis, muscular dystrophy); air
aspiration may also be therapeutic

Sonographic findings “ultrasound pictures” of Pseudo-Obstruction:
x Distended bowel loops with increased fluid content
x Small and large intestine may be affected
x Decreased peristalsis
x No obstruction of intestinal transit
x Bowel wall appears thinned
x The posterior walls of anterior bowel loops may not be visualized because of
dehiscence and intraluminal air.

Accuracy of sonographic diagnosis: The sonographic findings are unequivocal,
but the diagnosis remains uncertain because the cause cannot be determined. A
stenosing lesion may be missed at ultrasound examination. Doubts are resolved
by endoscopy and histologic evaluation of biopsy samples.

“Ultrasound Pictures” of Pseudo-obstruction: overdistended loops of colon with anterior intraluminal air (echogenic crescent). The plicae (arrows) and haustrations in this patient can still be identified

Ultrasound Tags: usg