# Systemic Sclerosis-Related Intestinal Pseudo-Obstruction Mimicking Mechanical Small Bowel Obstruction

## TL;DR

A case of intestinal pseudo-obstruction in a systemic sclerosis patient was mistaken for mechanical bowel blockage, highlighting the diagnostic challenge.

## Contribution

This case report emphasizes the importance of recognizing SSc-related intestinal pseudo-obstruction to avoid unnecessary surgery.

## Key findings

- A 66-year-old man with limited cutaneous SSc had recurrent symptoms mimicking mechanical small bowel obstruction.
- Diagnostic laparoscopy revealed no mechanical obstruction despite radiological features suggesting otherwise.
- The case underscores the need for a high index of suspicion for pseudo-obstruction in SSc patients with obstructive symptoms.

## Abstract

Gastrointestinal involvement is common in systemic sclerosis (SSc); however, intestinal pseudo-obstruction represents a rare and severe manifestation that may closely mimic mechanical small bowel obstruction (SBO). Differentiating functional pseudo-obstruction from true mechanical obstruction remains challenging due to overlapping clinical and radiological features, and recurrent presentations despite exclusion of an anatomic cause are uncommon. We report a case of a 66-year-old man with limited cutaneous SSc who presented with recurrent episodes of abdominal pain, vomiting, distension, and obstipation over a 24-month period. Cross-sectional imaging during multiple admissions consistently demonstrated features suggestive of mechanical SBO, including small bowel dilatation, apparent transition points, fecalization, and ultimately a hide-bound appearance. Despite these findings, diagnostic laparoscopy revealed no mechanical obstruction. The patient experienced transient improvement with conservative management but had repeated re-presentations with progressively convincing radiological features. Management was further complicated by intolerance and limited response to multiple prokinetic agents. This case highlights an important diagnostic pitfall in which SSc-related intestinal pseudo-obstruction may present as a recurrent and progressively misleading radiological mimic of mechanical SBO, even after operative exclusion of a mechanical cause. Recognition of this entity is essential to avoid unnecessary surgical intervention and to facilitate appropriate conservative, nutritional, and multidisciplinary management. Clinicians should maintain a high index of suspicion for pseudo-obstruction in patients with SSc who present with recurrent obstructive symptoms, particularly when imaging findings are discordant with operative or clinical progression.