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Chronic Intestinal Pseudo-Obstruction (CIPO) is a rare, severe motility disorder of the gastrointestinal tract characterized by signs and symptoms of intestinal obstruction without any mechanical blockage.

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It is due to failure of coordinated peristalsis from neuromuscular abnormalities affecting the enteric nervous system, smooth muscle, or both.

Etiopathology

Primary (idiopathic / genetic forms):

• Neuropathic: enteric nerve degeneration or maldevelopment (e.g., Hirschsprung-like syndromes, mitochondrial neurogastrointestinal encephalomyopathy – MNGIE).
• Myopathic: smooth muscle disorders (familial visceral myopathy, scleroderma-like).
• Mixed forms.

Secondary (acquired forms):

• Systemic diseases: scleroderma, systemic lupus erythematosus, amyloidosis, diabetes mellitus, Parkinson’s disease.
• Post-infectious neuropathies.
• Paraneoplastic syndromes (anti-Hu antibodies).
• Chronic use of drugs affecting motility (e.g., opioids, anticholinergics).

Clinical Presentation

• Chronic or recurrent episodes of bowel obstruction: abdominal pain, distension, bloating.
• Nausea, vomiting, constipation, or diarrhea.
• Malnutrition and weight loss due to poor absorption and dietary restriction.
• Pediatric cases: failure to thrive, feeding intolerance.
• Complications: bacterial overgrowth, sepsis, electrolyte imbalance, intestinal failure.