Audit of suspected chronic intestinal pseudo-obstruction in patients with gynecologic cancer

Purpose: To describe chronic intestinal pseudo-obstruction (IPO) syndromes that occur after radiotherapy or chemotherapy (or both) for gynecologic cancer. Methods: All 48 patients in the study population had a history of gynecologic cancer, treatment with radiotherapy or chemotherapy (or both), and suspected chronic IPO. The final diagnosis was based on clinical symptoms, radiographic imaging, motility studies, and surgical findings. Treatment was expectant for 27 patients and surgical for 21. Results: In six of the 21 surgical patients, the final diagnosis was mechanical obstruction. In the other 15, it was IPO syndrome: six had an idiopathic dysfunction (ID) and nine had a thick fibrinous coating (FC) on the serosal surface. Intestines of these 15 patients had patent lumens but decreased motility. The ID and FC groups differed in mean age, chemotherapy administration, and mean time from radiotherapy to surgery. Symptoms improved in 67% of FC patients compared with 17% of ID patients. Among patients treated expectantly, symptoms improved in 50% of the ID patients and in 38% of the FC patients. Motility studies were useful for distinguishing ID from FC or mechanical obstruction. Conclusion: Clinical history and motility studies may assist in diagnosing IPO syndrome in gynecologic cancer patients treated with radiotherapy or chemotherapy (or both) and in identifying patients who might benefit from surgical intervention.