Acute intestinal pseudo-obstruction in a patient with newly diagnosed type 2 diabetes mellitus: a case report

Acute intestinal pseudo-obstruction (AIPO) is characterized by acute dilation of the bowel in the absence of mechanical obstruction. It usually involves the colon (Ogilvie’s syndrome), but small bowel–predominant cases also occur. Association with type 2 diabetes mellitus (T2DM) at initial presentation is extremely rare. We describe a 52-year-old Ghanaian man presenting with acute abdominal distension, vomiting, and intractable hiccups. Initial laboratory investigations revealed hyperglycaemia (fasting blood glucose of 13.8 mmol/L; HbA1c 7.5%) consistent with newly diagnosed type 2 diabetes. Imaging suggested bowel obstruction: chest radiograph was essentially normal, while CT abdomen showed moderate fluid-filled distension of the distal esophagus, stomach, and small bowel, with a normal undistended colon and no obstructing lesion. He was managed conservatively with intravenous fluids, electrolyte correction, insulin, bowel stimulation, and pharmacologic control of hiccups. Over the course of 1 week, his abdominal distension resolved, bowel function returned, and he tolerated oral feeding. He was discharged on oral hypoglycaemic therapy and continues to do well on follow-up. This case describes acute intestinal pseudo-obstruction, small bowel predominant, occurring in a patient with newly diagnosed type 2 diabetes mellitus. Clinicians should be aware of gastrointestinal dysmotility as a potential early feature of diabetes.