Massive Gastric Distension from Chronic Intestinal Pseudo-Obstruction

A 68-year-old male with moderate mental retardation presented to the emergency department with anorexia, constipation, and abdominal distension for 4 days. Medical history was significant for partial colon resection for presumed bowel obstruction 3 years previously (no true anatomic cause for obstruction was identified at surgery). On examination, he was dehydrated and tachycardic, with blood pressure of 90/60 mmHg and a distended, tympanic, and mildly tender abdomen. Metabolic panel, amylase, and lipase test results were otherwise normal. An abdominal radiograph demonstrated marked gastric distension with multiple dilated loops of small and large bowel (Figure 1). Computed tomography of the abdomen with contrast confirmed the above findings but did not identify any mechanical cause for bowel obstruction (Figure 2). The patient had significant symptomatic improvement after intravenous