CASE REPORT   

Chirurgia 2002 August-October;15(4-5):147-50

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Intestinal pseudobstruction in an operated Crohn patient with a permanent ileostomy. Atony of terminal ileum syndrome: manometric evaluation

Bonventre S., Vetri G., Adamo M., Sirna G., Di Prima G., Passariello P., Di Gesù G.

Intestinal pseudobstruction is usually a particular clinical appearance of bowel occlusion without any mechanical obstruction and/or any functional pattern responsible for a dynamic ileus. This study proposes to present of a case of intestinal pseudobstruction in a patient who had undergone total proctocolectomy and permanent ileostomy for a colic Crohn's disease 22 years before. A transile-ostomy manometry shows a local hypotonicity of terminal ileus, in the absence of an histological relapse of this pathology. Recent pathogenetic hypotheses about Crohn's disease emphasize a fault of embryonic development of lymphatic vessels connected to omphalomesenteric duct, datable to around the 10th week, as a first alteration. On the basis of these hypotheses, more physiopathological and clinical considerations can be made: in this case a local aspecific phlogosis of terminal ileus can be considered as a real relapse without any histologic finding of Crohn's lesions, according to manometric functional intestinal evaluations.