Primary chronic intestinal pseudo-obstruction--an update.

Intestinal pseudo-obstruction is defined as a syndrome in which symptoms and signs of intestinal obstruction occur without evidence for a mechanical obstruction."2 Previous reviews3'4 have highlighted the heterogeneous nature of the syndrome with a wide variety of clinical associations, pathological abnormalities of the smooth muscle or myenteric plexus, and presenting features. The acute syndrome (Ogilvie's syndrome) has been associated with postsurgical, post-traumatic and medical conditions and is potentially reversible.5 Chronic intestinal pseudo-obstruction (CIPO) has been described in association with a large number of disease entities and drugs3'6 but no underlying cause can be identified in a proportion ofpatients in whom the disease is thought of as primary. The last few years have seen considerable advances in our understanding of primary CIPO. Both children and adults may be affected and