CASE 15759 Published on 30.05.2018

Stomach bending and chronic intestinal pseudo-obstruction in patient with autism

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

M. V. Pavlov, N. V. Orlova, Yu. V. Kulezneva, A. B. Abduraimov, K. A. Lesko

86, shosse Entuziastov Moscow, Russian Federation; Email: k.lesko@mknc.ru
Patient

20 years, female

Categories
Area of Interest Abdomen ; Imaging Technique Digital radiography
Clinical History

A 20-year-old woman with complaints of eructation and vomiting. She was diagnosed with autism when she was 3 years old. The patient is given probiotics, intestinal antiseptics, antibiotics, laxatives and enemas. She has followed a gluten-free diet since she was 5 years old. The patient already had episodes of such symptoms in the previous 12 years.

Imaging Findings

Abdominal X-ray showed severe dilation of the stomach, small bowel and colon without any signs of pneumoperitoneum or gas-fluid levels. The diameter of the colon was 70 mm approximately. The stomach was dilated and hypotonic. Periodically the stomach bended and became angulate. Gastric tone and peristalsis could be observed only in the antrum. Cardia gaped periodically. Barium study revealed continuous rugal pattern and fine mucosal relief without pooling of contrast material, filling defects and convergence of mucosal folds. Also it revealed stomach bending without signs of gastric volvulus. Real obstruction was excluded by barium passage through stomach and small intestine. There was adequate flow of contrast material out of the stomach.

Discussion

Large studies confirmed that some syndromes are more prevalent in people with autism, compared with non-autistic persons. The US Centers for Disease Control and Prevention analysis found that children with autism have a much higher sensibility to a wide group of diseases including gastro-intestinal disorders [1].
The mortality rate from gastrointestinal diseases was 40.8 times higher in patients with moderate to severe autism compared with non-autistic persons [2].
Food and respiratory allergies, including atopic manifestations and food intolerance are common in patients with autism [1, 3]. Large double-blind studies confirmed that patients with a history of allergic and atopic manifestations suffer from food sensitivities, but not due to coeliac disease [4, 5].
In the passt decade, gastrointestinal comorbidities in people with autism were recognised, such as increased permeability of the intestine wall, diarrhea, constipation, gastroesophageal reflux disease, deficiency of digestive enzymes and goitre [6-10]. Moreover, studies confirmed that the presence of gastrointestinal dysfunction in children with autism is not related to their eating habits or different side effects of drugs.
Analysis of the gut flora in patients with autism showed the presence of abnormal bacteria and atypical localisation of normal bowel bacteria [11, 12]. Serum levels of endotoxin were significantly higher in patients with autism and inversely and independently correlated with the severity of autism symptoms [13].
E. Emanuele et al [13] suspect that this phenomenon is a result of increased development of pathogenic bacteria in the gut and increased intestinal permeability in patients with autism. These studies revealed a spectrum of digestion disturbances in patients with autism including absorption pathology in the upper digestive tract, putrid and fermentative dyspepsia, abnormal metabolism of proteins and lipids, colitis as well as disturbances of motor-evacuation function of the large intestine. The latter is a part of neuronal and neuromuscular abnormalities, which are caused by increased intestinal permeability and immune imbalance, as well as disorders of neurological and neuroimmunological development [14]. Neuromuscular abnormalities can also lead to pseudo-obstruction.
Diagnostic radiology plays an important role in diagnosis and follow up of gastrointestinal disorders in patients with autism. Abdominal radiography and fluoroscopy are useful in these patients due to serious problems in communication and complaints revealing. These techniques are simple enough and relatively cheap for usage as a routine follow up method in this group of patients. Oral contrast study, including barium study, in patients with autism may help to differentiate stomach and pseudo-obstruction with small bowel obstruction and stomach volvulus.

Differential Diagnosis List
Stomach bending and chronic intestinal pseudo-obstruction
Acute dilatation of the stomach
Bowel obstruction
Gastric volvulus
Final Diagnosis
Stomach bending and chronic intestinal pseudo-obstruction
Case information
URL: https://www.eurorad.org/case/15759
DOI: 10.1594/EURORAD/CASE.15759
ISSN: 1563-4086
License