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Intestinal Pseudoobstruction Caused by Chronic Lyme Neuroborreliosis. A Case Report.

Schefte DF, Nordentoft T - J Neurogastroenterol Motil (2015)

Bottom Line: Intrathecal synthesis of anti-borrelia IgM and IgG and lymphocytosis in the cerebrospinal fluid was found, consistent with chronic Lyme neuroborreliosis since symptoms had lasted for more than six months.The patient's gastrointestinal function recovered and the pain subsided significantly following treatment with antibiotics.Lyme neuroborreliosis (LNB) often results in palsy, but rarely affects the autonomic nervous system.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.

ABSTRACT
Chronic intestinal pseudoobstruction is often classified as idiopathic. The condition is associated with poor quality of life and high morbidity, and treatment options are often unsatisfactory. A case of chronic intestinal pseudoobstruction in a 66-year-old woman, presenting with back and abdominal pain, urinary retention and severe constipation is described. The patient lived in an area in which Lyme disease is endemic and had been bitten by ixodes ticks. Intrathecal synthesis of anti-borrelia IgM and IgG and lymphocytosis in the cerebrospinal fluid was found, consistent with chronic Lyme neuroborreliosis since symptoms had lasted for more than six months. The patient's gastrointestinal function recovered and the pain subsided significantly following treatment with antibiotics. Lyme neuroborreliosis (LNB) often results in palsy, but rarely affects the autonomic nervous system. Three patients have been described with intestinal pseudoobstruction due to acute LNB. However, this is the first described case of intestinal pseudoobstruction due to chronic Lyme neuroborreliosis. LNB must be suspected in patients with intestinal pseudoobstruction, in particular in patients who have been bitten by an ixodes tick and in patients living in an endemic area.

No MeSH data available.


Related in: MedlinePlus

Abdominal X-ray of the patient with chronic intestinal pseudoobstruction due to chronic Lyme neuroborreliosis showed colonic ileus with dilation of the colon. Subsequent barium X-ray excluded intestinal obstruction and the condition was interpreted as intestinal pseudoobstruction.
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f1-jnm-21-440: Abdominal X-ray of the patient with chronic intestinal pseudoobstruction due to chronic Lyme neuroborreliosis showed colonic ileus with dilation of the colon. Subsequent barium X-ray excluded intestinal obstruction and the condition was interpreted as intestinal pseudoobstruction.

Mentions: Spinal MRI revealed a suspected right-sided paramedian disc prolapse at L4/L5 with impingement of the L5 nerve root and a small disc prolapse at L5/S1. This was treated conservatively with physiotherapy and analgesia, including opioids. While the urinary retention resolved spontaneously, the pain intensified and the patient developed severe constipation, unresponsive to laxatives. Abdominal X-ray and CT scan suspected colonic ileus with some dilation of the colon (Figure). Absence of intestinal obstruction was confirmed by barium X-ray and the condition was interpreted as intestinal pseudoobstruction resulting from opioid therapy. Treatment with an acetylcholinesterase inhibitor resulted in defecation and flatulence, but the effects were only temporary. Colonoscopy revealed a flaccid, poorly-prepared bowel, but no other pathology was found. Colonic transit time investigation showed significantly delayed colonic emptying. Treatment with laxatives was intensified and transanal irrigation initiated.


Intestinal Pseudoobstruction Caused by Chronic Lyme Neuroborreliosis. A Case Report.

Schefte DF, Nordentoft T - J Neurogastroenterol Motil (2015)

Abdominal X-ray of the patient with chronic intestinal pseudoobstruction due to chronic Lyme neuroborreliosis showed colonic ileus with dilation of the colon. Subsequent barium X-ray excluded intestinal obstruction and the condition was interpreted as intestinal pseudoobstruction.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496901&req=5

f1-jnm-21-440: Abdominal X-ray of the patient with chronic intestinal pseudoobstruction due to chronic Lyme neuroborreliosis showed colonic ileus with dilation of the colon. Subsequent barium X-ray excluded intestinal obstruction and the condition was interpreted as intestinal pseudoobstruction.
Mentions: Spinal MRI revealed a suspected right-sided paramedian disc prolapse at L4/L5 with impingement of the L5 nerve root and a small disc prolapse at L5/S1. This was treated conservatively with physiotherapy and analgesia, including opioids. While the urinary retention resolved spontaneously, the pain intensified and the patient developed severe constipation, unresponsive to laxatives. Abdominal X-ray and CT scan suspected colonic ileus with some dilation of the colon (Figure). Absence of intestinal obstruction was confirmed by barium X-ray and the condition was interpreted as intestinal pseudoobstruction resulting from opioid therapy. Treatment with an acetylcholinesterase inhibitor resulted in defecation and flatulence, but the effects were only temporary. Colonoscopy revealed a flaccid, poorly-prepared bowel, but no other pathology was found. Colonic transit time investigation showed significantly delayed colonic emptying. Treatment with laxatives was intensified and transanal irrigation initiated.

Bottom Line: Intrathecal synthesis of anti-borrelia IgM and IgG and lymphocytosis in the cerebrospinal fluid was found, consistent with chronic Lyme neuroborreliosis since symptoms had lasted for more than six months.The patient's gastrointestinal function recovered and the pain subsided significantly following treatment with antibiotics.Lyme neuroborreliosis (LNB) often results in palsy, but rarely affects the autonomic nervous system.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.

ABSTRACT
Chronic intestinal pseudoobstruction is often classified as idiopathic. The condition is associated with poor quality of life and high morbidity, and treatment options are often unsatisfactory. A case of chronic intestinal pseudoobstruction in a 66-year-old woman, presenting with back and abdominal pain, urinary retention and severe constipation is described. The patient lived in an area in which Lyme disease is endemic and had been bitten by ixodes ticks. Intrathecal synthesis of anti-borrelia IgM and IgG and lymphocytosis in the cerebrospinal fluid was found, consistent with chronic Lyme neuroborreliosis since symptoms had lasted for more than six months. The patient's gastrointestinal function recovered and the pain subsided significantly following treatment with antibiotics. Lyme neuroborreliosis (LNB) often results in palsy, but rarely affects the autonomic nervous system. Three patients have been described with intestinal pseudoobstruction due to acute LNB. However, this is the first described case of intestinal pseudoobstruction due to chronic Lyme neuroborreliosis. LNB must be suspected in patients with intestinal pseudoobstruction, in particular in patients who have been bitten by an ixodes tick and in patients living in an endemic area.

No MeSH data available.


Related in: MedlinePlus