Is the spasm location needed to treat idiopathic spasticity?

Question

Hello doctor,

I have a rare disease called idiopathic spastic intestinal obstruction or spastic ileus with a 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, and MRI revealed nothing.

So, we can determine the location of a spasm only with X-ray and barium follow-through. I did a barium follow-through several times (with an interval of six months). There was a disagreement among the doctors, and they agreed aboutthe etiology of obstruction (dynamic or spastic), but could not decide the location of the spasm.

Treatment recommended is therapeutic - endoscopic injections of Botulinum toxin into the intestine (they call it chemical denervation, and recommend it because conservative drug therapy does not help. Therefore, it is important to know the exact location of the spasm. I ask for help in this matter.

I am attaching the reports. The study was started 11 and a half hours after swallowing barium. The last shot was taken 35 hours after swallowing barium. So, there is stasis or stagnation for 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.

Please help.

Thanks in advance.

Answer 1

Hello,

Welcome to icliniq.com.

The condition, idiopathic spastic intestinal obstruction or spastic ileus,s is unique and rare indeed. In the barium pictures, the involved area is usually seen as 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 studywass 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, which 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 as narrow in some of the images, but that can be normal.

Please write back with your doubts.

Hope you find this helpful.

Thank you.