Obstruction and pseudo-obstruction in inflammatory bowel disease
Intestinal obstruction and pseudo-obstruction represents a
severe complication and a potential emergency in Crohn's
disease and ulcerative colitis. Such intestinal complications
are of great importance and may require urgent surgical
management. This review discusses the clinical importance,
the risk factors and the pathophysiological basis of this phenomenon.
Diagnosis and imaging of obstruction together
with common and rare causes of obstruction and pseudo-obstruction
including toxic megacolon are extensively reviewed.
Non-surgical treatment of obstruction in inflammatory bowel
disease is reviewed including pharmacologic colonic decompression
and infliximab use. Endoscopy in pseudo-obstruction,
toxic megacolon, and in stenoses and strictures is
reviewed and the setting of the optimal time for surgery in
obstructing cases is provided. Strictureplasty or resection
in stenoses, post-surgical obstructions as well as available
prognostic markers of obstruction and pseudo-obstruction
are critically revised.