Chronic intestinal pseudo-obstruction. Management with total parenteral nutrition and a venting enterostomy
H. A. Pitt, L. L. Mann, W. E. Berquist, M. E. Ament, E. W. Fonkalsrud and L. DenBesten
A variety of remedies have been suggested for patients with chronic
intestinal pseudo-obstruction. However, none of these treatments have been
particularly effective, and many of these patients have died of
malnutrition. Therefore, in an effort to maintain nutrition and avoid
repetitive nasogastric intubation, 22 patients (12 adults and ten children)
with chronic intestinal pseudo-obstruction were managed with long-term
total parenteral nutrition (TPN), and 20 also received a "venting"
enterostomy. Only two patients had to undergo revision of their
gastrostomies. Prior to referral, these 22 patients required 56 admissions
for obstruction (1.2 admissions per patient-year). Since the initiation of
TPN and placement of a venting enterostomy, these 22 patients required only
17 hospitalizations for obstruction in a total of 80 patient years (0.2
admissions per patient-year). We conclude that patients with chronic
intestinal pseudo-obstruction who receive TPN at home and have a venting
enterostomy can be safely managed for prolonged periods and require fewer
hospitalizations for obstruction.
