Chronic intestinal pseudo-obstruction (CIPO) is a rare, highly morbid disorder characterised by signs and symptoms of intestinal obstruction in the absence of mechanical obstruction.¹ With no specific aetiology to tackle, management of CIPO focuses on symptom control and maintenance of an adequate nutritional status. Intractable chronic abdominal pain is a frequent and distressing feature in CIPO.

Here we report on the effect of bilateral thoracoscopic splanchnicectomy (TS) in two boys, one mentally retarded, with severe CIPO refractory to conventional therapy. Their debilitating chronic abdominal pain and markedly impaired quality of life (QoL) was iteratively alleviated by transient bilateral coeliac blocks (CB). After 26 and 9 successful CB, respectively, TS was performed. The greater and lesser splanchnic nerves were coagulated and divided bilaterally in both patients (fig 1).