Bowel obstruction in a patient with systemic sclerosis

Norman Todd Ilowite, D. Gold, M. Mantinaos, F. Bierman, D. Mehrotra, M. Gandhi, I. R. Shenker, B. Gauthier

Research output: Contribution to journalArticle

Abstract

A 15-year-old female with progressive systemic sclerosis presented with a three day history of fever, acute periumbilical abdominal pain and vomiting. She had a history of sexual abuse that required abdominal surgery with a colostomy. On physical exam, the temperature was 38.3°C, the abdomen was mildly distended and diffusely tender with hypoactive bowel sounds and rebound. Joints and skin had evidence of systemic sclerosis. Plain abdominal x-ray showed dilated small bowel and some features atypical of mechanical obstruction: the folds were tightly packed and the small bowel had the hidebound appearance described in systemic sclerosis and there were no air fluid levels. A small bowel series also showed tightly packed folds and a delayed transit time (8 to 10 hours). It was thought that the findings were those of systemic sclerosis rather than mechanical obstruction possibly related to adhesions. About 85% of patients with scleroderma have gastrointestinal involvement, which remains subclinical, though causing radiological abnormalities in 50%. Therefore the radiological findings in this patient did not necessarily mean that the obstruction was related to the systemic sclerosis. In fact, the obstruction resolved promptly with nasogastric aspiration and a subsequent motility study was normal. It was concluded that the intestinal obstruction had been mechanical, though only partial, but that the patient might well develop systemic sclerosis related gastrointestinal disease with time. There is no treatment proved to be effective for progressive systemic sclerosis but there is evidence that immunosuppression for severe organ involvement, treatment of hypertension with angiotensin converting enzyme inhibitors and supportive treatment for skin and gut, often result in a good clinical outcome.

Original languageEnglish (US)
Pages (from-to)175-178
Number of pages4
JournalChildren's Hospital Quarterly
Volume11
Issue number4
StatePublished - 2000
Externally publishedYes

Fingerprint

Systemic Scleroderma
Diffuse Scleroderma
Skin
Colostomy
Gastrointestinal Diseases
Intestinal Obstruction
Sex Offenses
Angiotensin-Converting Enzyme Inhibitors
Abdomen
Immunosuppression
Abdominal Pain
Vomiting
Fever
Therapeutics
Joints
Air
X-Rays
Hypertension
Temperature

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Ilowite, N. T., Gold, D., Mantinaos, M., Bierman, F., Mehrotra, D., Gandhi, M., ... Gauthier, B. (2000). Bowel obstruction in a patient with systemic sclerosis. Children's Hospital Quarterly, 11(4), 175-178.

Bowel obstruction in a patient with systemic sclerosis. / Ilowite, Norman Todd; Gold, D.; Mantinaos, M.; Bierman, F.; Mehrotra, D.; Gandhi, M.; Shenker, I. R.; Gauthier, B.

In: Children's Hospital Quarterly, Vol. 11, No. 4, 2000, p. 175-178.

Research output: Contribution to journalArticle

Ilowite, NT, Gold, D, Mantinaos, M, Bierman, F, Mehrotra, D, Gandhi, M, Shenker, IR & Gauthier, B 2000, 'Bowel obstruction in a patient with systemic sclerosis', Children's Hospital Quarterly, vol. 11, no. 4, pp. 175-178.
Ilowite NT, Gold D, Mantinaos M, Bierman F, Mehrotra D, Gandhi M et al. Bowel obstruction in a patient with systemic sclerosis. Children's Hospital Quarterly. 2000;11(4):175-178.
Ilowite, Norman Todd ; Gold, D. ; Mantinaos, M. ; Bierman, F. ; Mehrotra, D. ; Gandhi, M. ; Shenker, I. R. ; Gauthier, B. / Bowel obstruction in a patient with systemic sclerosis. In: Children's Hospital Quarterly. 2000 ; Vol. 11, No. 4. pp. 175-178.
@article{1b0e2085c4814ca3a090a596392ba834,
title = "Bowel obstruction in a patient with systemic sclerosis",
abstract = "A 15-year-old female with progressive systemic sclerosis presented with a three day history of fever, acute periumbilical abdominal pain and vomiting. She had a history of sexual abuse that required abdominal surgery with a colostomy. On physical exam, the temperature was 38.3°C, the abdomen was mildly distended and diffusely tender with hypoactive bowel sounds and rebound. Joints and skin had evidence of systemic sclerosis. Plain abdominal x-ray showed dilated small bowel and some features atypical of mechanical obstruction: the folds were tightly packed and the small bowel had the hidebound appearance described in systemic sclerosis and there were no air fluid levels. A small bowel series also showed tightly packed folds and a delayed transit time (8 to 10 hours). It was thought that the findings were those of systemic sclerosis rather than mechanical obstruction possibly related to adhesions. About 85{\%} of patients with scleroderma have gastrointestinal involvement, which remains subclinical, though causing radiological abnormalities in 50{\%}. Therefore the radiological findings in this patient did not necessarily mean that the obstruction was related to the systemic sclerosis. In fact, the obstruction resolved promptly with nasogastric aspiration and a subsequent motility study was normal. It was concluded that the intestinal obstruction had been mechanical, though only partial, but that the patient might well develop systemic sclerosis related gastrointestinal disease with time. There is no treatment proved to be effective for progressive systemic sclerosis but there is evidence that immunosuppression for severe organ involvement, treatment of hypertension with angiotensin converting enzyme inhibitors and supportive treatment for skin and gut, often result in a good clinical outcome.",
author = "Ilowite, {Norman Todd} and D. Gold and M. Mantinaos and F. Bierman and D. Mehrotra and M. Gandhi and Shenker, {I. R.} and B. Gauthier",
year = "2000",
language = "English (US)",
volume = "11",
pages = "175--178",
journal = "Children's Hospital Quarterly",
issn = "0899-5869",
publisher = "Kluwer/Plenum Publishers",
number = "4",

}

TY - JOUR

T1 - Bowel obstruction in a patient with systemic sclerosis

AU - Ilowite, Norman Todd

AU - Gold, D.

AU - Mantinaos, M.

AU - Bierman, F.

AU - Mehrotra, D.

AU - Gandhi, M.

AU - Shenker, I. R.

AU - Gauthier, B.

PY - 2000

Y1 - 2000

N2 - A 15-year-old female with progressive systemic sclerosis presented with a three day history of fever, acute periumbilical abdominal pain and vomiting. She had a history of sexual abuse that required abdominal surgery with a colostomy. On physical exam, the temperature was 38.3°C, the abdomen was mildly distended and diffusely tender with hypoactive bowel sounds and rebound. Joints and skin had evidence of systemic sclerosis. Plain abdominal x-ray showed dilated small bowel and some features atypical of mechanical obstruction: the folds were tightly packed and the small bowel had the hidebound appearance described in systemic sclerosis and there were no air fluid levels. A small bowel series also showed tightly packed folds and a delayed transit time (8 to 10 hours). It was thought that the findings were those of systemic sclerosis rather than mechanical obstruction possibly related to adhesions. About 85% of patients with scleroderma have gastrointestinal involvement, which remains subclinical, though causing radiological abnormalities in 50%. Therefore the radiological findings in this patient did not necessarily mean that the obstruction was related to the systemic sclerosis. In fact, the obstruction resolved promptly with nasogastric aspiration and a subsequent motility study was normal. It was concluded that the intestinal obstruction had been mechanical, though only partial, but that the patient might well develop systemic sclerosis related gastrointestinal disease with time. There is no treatment proved to be effective for progressive systemic sclerosis but there is evidence that immunosuppression for severe organ involvement, treatment of hypertension with angiotensin converting enzyme inhibitors and supportive treatment for skin and gut, often result in a good clinical outcome.

AB - A 15-year-old female with progressive systemic sclerosis presented with a three day history of fever, acute periumbilical abdominal pain and vomiting. She had a history of sexual abuse that required abdominal surgery with a colostomy. On physical exam, the temperature was 38.3°C, the abdomen was mildly distended and diffusely tender with hypoactive bowel sounds and rebound. Joints and skin had evidence of systemic sclerosis. Plain abdominal x-ray showed dilated small bowel and some features atypical of mechanical obstruction: the folds were tightly packed and the small bowel had the hidebound appearance described in systemic sclerosis and there were no air fluid levels. A small bowel series also showed tightly packed folds and a delayed transit time (8 to 10 hours). It was thought that the findings were those of systemic sclerosis rather than mechanical obstruction possibly related to adhesions. About 85% of patients with scleroderma have gastrointestinal involvement, which remains subclinical, though causing radiological abnormalities in 50%. Therefore the radiological findings in this patient did not necessarily mean that the obstruction was related to the systemic sclerosis. In fact, the obstruction resolved promptly with nasogastric aspiration and a subsequent motility study was normal. It was concluded that the intestinal obstruction had been mechanical, though only partial, but that the patient might well develop systemic sclerosis related gastrointestinal disease with time. There is no treatment proved to be effective for progressive systemic sclerosis but there is evidence that immunosuppression for severe organ involvement, treatment of hypertension with angiotensin converting enzyme inhibitors and supportive treatment for skin and gut, often result in a good clinical outcome.

UR - http://www.scopus.com/inward/record.url?scp=0033756585&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033756585&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:0033756585

VL - 11

SP - 175

EP - 178

JO - Children's Hospital Quarterly

JF - Children's Hospital Quarterly

SN - 0899-5869

IS - 4

ER -