Intestinal pseudo-obstruction can be defined as an occlusive syndrome, with the signs and symptoms of intestinal obstruction, but without mechanical obstacle. The pathophysiological alterations causing the impairment of intestinal transit can be localized in different locations of the intestinal tract, such as the esophagus, stomach, duodenum, small intestine, colon, rectum. On the basis of the clinical manifestations, acute and chronic forms of intestinal pseudo-obstructions can be identified.
In acute forms the alteration can be functional of a reflex nature or due to morpho-functional impairment of the intestinal autonomic nervous system. Chronic forms can be secondary, idiopathic and congenital. In all forms, differentiated on the etiological basis, the pathogenetic mechanism of chronic pseudo-obstruction is determined by the neuropathic or myopathic mechanism. The clinical examination allows us to formulate the suspicion of pseudo-obstruction and clinical-instrumental objectivity of acute and chronic pseudo-obstructions, must present the symptoms and signs of intestinal obstruction which must therefore be recorded, also by instrumental imaging tests (US, CT, MRI), but the diagnostic process must be completed by the exclusion of any mechanical obstacle. Acute forms from transient causes resolve quickly and completely following treatment of the underlying pathology. Chronic forms secondary to serious underlying diseases cause greater therapeutic problems. In chronic idiopathic forms, due to alterations of the autonomic nervous system, the use of acetylcholinesterase inhibitor drugs or metoclopramide (direct stimulation of smooth muscles) has in some cases been useful. Surgical intervention is justified as a measure of necessity in conditions not sensitive to medical therapy and, above all, when serious and continuous symptoms can be linked to a particular section of the digestive tract.

Conventional treatment of small bowel occlusion has been reviewed based on the recent literature acquisitions, followed by personal observations. Some small bowel occlusion syndromes require a different therapeutic approach and have a varying prognosis. Acute small bowel occlusion can be divided into the full blown cases, as complete small bowel obstruction (C-SBO), and also occlusions with probable strangulation requiring immediate surgical intervention, and the other group that includes the simple or partial small bowel obstruction (P-SBO) with the same, but moderate symptoms. In this second group indications for surgery are not urgent. Frequently a brief period of intestinal decompression and conservative medical treatment can achieve stable recovery.

Keywords
Intestinal pseudo-obstruction, Pathogenesis of psudo-obstruction, Management of pseudo-obstruction, Small bowel occlusion,
Management SBO, Complete SBO, Partial SBO.