Intestinal pseudo-obstruction: An uncommon condition with heterogeneous etiology and unpredictable outcome

Figure 1 Supine radiograph with no preparation showing massive colonic distention especially the transverse colon, but without air-fluid levels.

Figure 2 Colonoscopy showing huge colonic distension involving all segments, with a diameter of the rectosigmoid and descending colon greater than 12 cm, and that of the ascending colon and cecum greater than 16-18 cm.

Figure 3 Laparotomy showing massive distension of the whole colon with no perforation or volvulus. Total colectomy removed a completely atonic colon which was 2.5 m in length and 25 cm in diameter. Ileoanal pouch was made subsequently.

Figure 4 Full-thickness serial biopsies stained with haematoxylin-eosin (× 100) from the removed colon showing no ganglionic cells in the last 7 cm of the rectum. Marked depletion of ganglionic cells (arrow) and hypertrophy of the external muscular layer were identified in sigmoid (A) and descending colon (B).