P3811 - Alcohol-Induced Chronic Intestinal Pseudo-Obstruction

Toni Habib, MD¹, Sindhura Kolli, MD^2
1Staten Island University Hospital, Northwell Health, Staten Island, NY; ²Elmhurst Hospital Center / Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: Alcohol-induced chronic intestinal pseudo-obstruction (AI-CIPO) is a rare occurring disruption in colonic motility. The etiology remains unclear which underscores the value of literature contributing to this occurrence. We present a case of AI-CIPO in an elderly male whose comorbidities made the minimally available remedies contraindicated.

Case Description/Methods: A 65-year-old man with a past medical history of atrial fibrillation and heart failure requiring an implantable defibrillator presented with acute nausea after binge drinking alcohol. He reported chronic non-bilious, non-bloody diarrhea starting 4 months prior. Vitals were normal. Labs were normal except for hypokalemia of 2.1 and hypomagnesemia of 1.1. Interrogation of his defibrillator revealed episodes of ventricular fibrillation terminated with a shock. CT scan of abdomen demonstrated a dilatation of the transverse colon upto 14 cm refractory to rectal tube decompression. A colonoscope was advanced to the transverse colon for decompression and further abetted by deployment of a colonic decompression tube that would be removed two days later. Despite an aggressive bowel regimen with concurrent electrolyte replacement, daily abdominal x-rays displayed worsened transverse colonic dilatation up to 17cm refractory to 3 more colonoscope decompressions. Subsequently, the patient was offered a colectomy which he refused and left against medical advice.

Discussion: AI-CIPO physiological development remains murky. Alcohol has both a direct neurotoxic effect and an indirect effect caused by deficiencies in thiamine or electrolytes. It has a dose-related effect on parasympathetic denervation, which supplies the hindgut around and distal to the splenic flexure. It also has a myotoxic effect on smooth muscle proteins and RNA.

Most patients present with abdominal pain, nausea, vomiting. With chronicity, diarrhea and weight loss dominate. Diagnosis is by x-rays and CT images. Endoscopies and colonoscopies serve as diagnostic and therapeutic options. Treatment involves treating the etiology, aggressive correction of electrolytes, a bowel regimen, and decompression with a colonoscopy or decompression stent. Promotility off-label agents include erythromycin, metoclopramide, and neostigmine, but have adverse cardiac effects. Supportive treatment involves fluid administration, parenteral nutrition via a percutaneous endoscopic gastrostomy or jejunostomy. A last resort would be a colectomy while alcohol abstinence would prevent recurrences.



Disclosures:


Toni Habib, MD¹, Sindhura Kolli, MD². P3811 - Alcohol-Induced Chronic Intestinal Pseudo-Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.