A chronic idiopathic intestinal pseudo-obstruction triggered by pregnancy

A 23-year-old woman presented with a history of repeated abdominal pain and vomiting since the 12th gestational week. Radiological studies revealed dilatation of the entire small intestine without mechanical obstruction, and dysmotility of the ileocecal region was suspected. Her symptoms continued after delivery, despite conservative treatment, and ileocecal resection was performed at age 24 years. The resected specimen showed a remarkable decrease in the density of enteric ganglion cells, therefore chronic idiopathic intestinal pseudo-obstruction (CUP) was diagnosed. Subtotal colectomy was subsequently performed at 25 years of age, but her symptoms persisted. Long-term parenteral nutrition became difficult because of catheter-related complications and her nutritional status worsened. Therefore, at age 29 she underwent jejunostomy, and her symptoms improved. She is now able to eat and her nutritional status continues to improve. Autoimmune abnormality has recently been reported to be one of the causes of CUP, and some relation between pregnancy and autoimmune disease has been recognized. Our case suggests that immunological changes during pregnancy may cause CUP.