Surgery in Intestinal Pseudo‐Obstruction: Pro

Paediatric Intestinal Pseudo‐obstruction

“…Surgery has an important role to play in the diagnosis of PIPO (3,4,23).Even in the era of the extremely sophisticated manometric techniques and imaging modalities, surgical exploration may be necessary to definitively confirm or exclude the presence of a mechanical occlusion of the gut (144). Regrettably, data regarding the value of surgery for mere diagnostic purposes in children with PIPO are scarce; furthermore there is global agreement amongst experts in the field that unnecessary surgeries should be avoided in these patients (3,4,144). This dogma is based on the fact that children with PIPO demonstrate a strong propensity to form dense adhesions after surgery and experience problematic recovery due to prolonged post-surgical paralytic ileus (4).…”

Pneumoperitoneum without intestinal perforation in an adolescent girl

“…Both non‐surgical pneumoperitoneum and CIPOS are rare conditions, especially in children. In pathogenesis, the symptoms of CIPOS were generated by failure of the intestinal pump in the absence of gut‐occluding lesions, leading to abnormal intestinal tract peristalsis and finally nutritional disorders 1,2 . The condition may be a primary disorder of enteric neuromusculature or secondary to a variety of pathological conditions 2 .…”

“…The diagnosis of CIPOS via surgical exploration should be avoided 1 . Surgery may predispose the patient to develop later adhesions.…”

“…Recently, laparoscopy was used to obtain biopsies and reduce the risk of adhesion 2,8 . Laparotomy would be reserved for performing an enterostomy or ruling out bowel obstruction and should not be undertaken only for obtaining biopsies 1 …”

“…However, total parenteral nutrition can cause major morbidity and mortality in its long‐term use. Intestinal transplantation is the only definite curative treatment for the CIPOS patient after failure of medical and surgical treatment 1 . Overall, the prognosis of CIPOS is poor.…”