Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4512
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
Processing time: 188 Days and 18.9 Hours
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.
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.
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.