Gut , 1960 , 1 , 62 . INTESTINAL PSEUDO - OBSTRUCTION WITH STEATORRHOEA

In the past few years we have encountered three cases of intractable wasting and diarrhoea in which attacks of intestinal pseudo-obstruction have occurred. Two of them will not be discussed in detail because in one, a woman of 52 years, the jejunum showed the histological appearances of adult coeliac disease as described by Paulley (1954) and Shiner (1956). At laparotomy the peristaltic activity of the small intestine was grossly abnormal, showing violent segmentation movements. It was impossible to alleviate her condition, from which she had suffered for 20 years, and she has recently died elsewhere, some three years after coming under our care. Another patient, a woman, aged 56, who in four years had two attacks of pseudo-obstruction leading to laparotomy and lost 70 lb. from steatorrhoea, was eventually explored for a perforation, and a very small reticulo-sarcoma of the ileum was found, from which she died soon after. It is extremely doubtful whether this sarcoma could have accounted for the long preceding history. Our third patient, a man aged 36, has been carefully investigated both by us and by Dr. Avery Jones at the Central Middlesex Hospital, and so far we have not been able either to find a known cause for his condition or to alleviate it substantially. The main features of this case, similar in many respects to the two previously mentioned, are (1) a long history of colicky, abdominal pain; (2) fatty diarrhoea, malabsorption, and loss of weight; (3) gross abdominal distention with audible and visible intestinal peristalsis; (4) episodes of pseudoobstruction; (5) no mechanical cause for obstruction found at laparotomy; (6) marked segmentation movements of the gut visible radiologically and at laparotomy; (7) absence of hydroxyindoleacetic