Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Spontaneous resolution of idiopathic intestinal obstruction after pneumonia: A case report
Bing-Qing Zhang, Xiao-Yan Dai, Qiu-Yue Ye, Long Chang, Zhi-Wei Wang, Xiao-Qing Li, Yong-Ning Li
Bing-Qing Zhang, Long Chang, Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Xiao-Yan Dai, Qiu-Yue Ye, International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Zhi-Wei Wang, Interventional Section, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Xiao-Qing Li, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Yong-Ning Li, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Author contributions: Zhang BQ, Dai XY, Ye QY, Chang L were the general medicine doctors who attended to the patient’s care; Wang ZW was the radiologist who performed the upper gastrointestinal radiography and helped with all the images; Li XQ was the gastroenterologist responsible for gastrointestinal management; Li YN helped coordinate all the multidisciplinary consultations; Zhang BQ wrote the manuscript, and Li XQ revised the manuscript critically; all authors provided final approval of the manuscript.
Supported by Peking Union Medical College Hospital Science Fund for Junior Faculty, No. pumch-2016-2.13.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and the accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Qing Li, MD, Associate Professor, Doctor, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. lixiaoqing20060417@126.com
Received: March 23, 2020
Peer-review started: March 25, 2020
First decision: July 25, 2020
Revised: August 4, 2020
Accepted: August 20, 2020
Article in press: August 20, 2020
Published online: October 6, 2020
BACKGROUND
Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction. Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine. Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction. Here, we report a unique case of idiopathic mechanical duodenal obstruction, which resolved spontaneously after 3 mo of conservative treatment, but was followed by intestinal pseudo-obstruction.
CASE SUMMARY
An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia. Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause. Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection. Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely. Unfortunately, 2 wk later, she had regurgitation and postprandial vomiting again, complicated by deteriorating wheezing and dyspnea. Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration. The patient fully recovered after combined treatment with antireflux agents, enema, prokinetics, and bronchodilators.
CONCLUSION
This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction, which requires multidisciplinary treatment.
Core Tip: We report an 84-year-old female patient with idiopathic mechanical duodenal obstruction during recovery from a community-acquired pneumonia. Her condition deteriorated with strenuous investigations and conservative treatment. Furthermore, she had persistent pulmonary infection leading to septic shock, followed by probable fungal infection. Along with the control of pulmonary infection, her intestinal obstruction resolved spontaneously. Two weeks later, her symptoms of ileus relapsed without mechanic factors, complicated by airway hyperresponsiveness. Finally, the patient had full recovery with concomitant treatment involving both intestine and pulmonary dysfunction.
