Q. I have idiopathic spastic intestinal obstruction. Can you specify the exact location?
Hello doctor,
I have a rare disease called idiopathic spastic intestinal obstruction or spastic ileus with chronic, long-term course (barium stays about 40 hours in the small intestine). On a two-balloon endoscopy of the small intestine, colonoscopy with ileoscopy, CT, MRI revealed nothing. So, we can determine the location of spasm only with X-ray and barium follow through. I did barium follow through several times (with an interval of six months). There was a disagreement among the doctors and they agreed about etiology of obstruction (dynamic or spastic), but cannot decide the location of the spasm. Treatment recommended is therapeutical - endoscopic injections of Botulinum toxin into the intestine (they call it chemical denervation, and recommend it because that conservative drug therapy does not help. Therefore, it is important to know the exact location of spasm. I ask for help in this matter. I am attaching the links. The study was started 11 and half hours after swallowing barium. The last shot was taken 35 hours after swallowing barium. So, there is stasis or stagnation about 30 hours in the small intestine.
The most important question is the exact location of the spastic area. It is important to know the location and length of spasm in centimeters, at least in some ranges (if absolute accuracy is not possible, but if it is possible, at least within the margin of error of a few cm, that would be perfect). This information is necessary for the doctor to develop further treatment tactics. Thanks in advance.
Hello,
Welcome to icliniq.com.
The condition idiopathic spastic intestinal obstruction or spastic ileus is a unique and rare condition indeed. In the barium pictures, the involved area is usually seen like a sudden constriction of a segment of the small or large bowel. The segment involved can be visualized as a thin pencil-like narrowing. There can be one location involved or it can involve multiple short or long segments. The usual findings are a sudden narrowing of the bowel for a few inches.
Your barium swallow images done on the 5th (attachment removed to protect patient identity), show a normal transit of barium in the esophagus and into the stomach lumen. The study is started at 10.10 AM and we can see the barium in the jejunum in the 11.27 image. There is no narrowing in the segments visualized.
In the 06.03 PM image, there is a suspicious short segment of sudden narrowing of bowel in the right lower pelvis and is likely one of the affected areas.
In the second series of images done on the 18th, there is no severe narrowing in any particular area. The ileocecal junction is seen narrow in some of the images but that can be normal.
Please write back with your doubts.
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