Unmasking the “Braided” Bowel: Chronic Intestinal Pseudo-Obstruction—A Case Report

Background and Clinical Significance: Chronic intestinal pseudo-obstruction (CIPO) clinically presents as a mechanical obstruction. When patients present with signs of impending ischemia, emergency exploratory laparotomy is indicated. Differentiating CIPO from other etiologies preoperatively is highly challenging, making intraoperative findings and definitive histopathology crucial for an accurate diagnosis. This report aims to elucidate a novel macroscopic presentation of myopathic CIPO and explore the potential biomechanical mechanisms underlying the observed structural anomaly. Case Presentation: A 37-year-old male with no prior abdominal surgery presented with a high-grade bowel obstruction and early signs of ischemia. Emergency laparotomy revealed a unique “braided dough twist” anomaly of the distal small bowel, prompting a segmental resection. Subsequent histopathological and immunohistochemical evaluations revealed severe outer longitudinal muscle atrophy with an intact enteric nervous system, confirming myopathic CIPO. Following surgery, the patient recovered uneventfully with significant nutritional improvement. Conclusions: Myopathic CIPO can manifest as a striking “braided” bowel anomaly—a macroscopic presentation previously undocumented in the literature. This case illustrates that determining the optimal extent of resection relies heavily on intraoperative visual and tactile assessment, and that comprehensive histopathological profiling is essential for establishing a definitive diagnosis and elucidating the underlying biomechanical mechanisms of this unique structural anomaly.