<p>Alcohol-induced chronic intestinal pseudo-obstruction (AI-CIPO) is a rare occurring disruption in colonic motility. We present a case of AI-CIPO in an elderly male whose comorbidities made the minimally available remedies contraindicated. A 65-year-old man presented with a dilatation of the transverse colon up to 14&#xa0;cm requiring rectal tube decompression. Despite an aggressive bowel regimen with concurrent electrolyte repletion, daily abdominal x-rays displayed worsened transverse colonic dilatation up to 17&#xa0;cm, which was refractory to three colonoscope decompressions. Due to inadequate response to treatment, the patient was offered a colectomy. Alcohol can have direct and indirect neurotoxic effects. It has a dose-related effect on parasympathetic denervation and myotoxic effects on smooth muscle proteins and RNA. Most patients present with abdominal pain, nausea, and vomiting and are often diagnosed with abdominal imaging. Other diagnostic modalities are endoscopies and colonoscopies, which can also serve as therapeutic options. A multimodal approach is key to treatment, which involves addressing the underlying etiology, aggressive correction of electrolytes, a bowel regimen, and endoscopic/colonoscopic decompression. Promotility agents can be used in certain cases but have cardiac adverse effects. Supportive treatment involves fluid administration and parenteral nutrition. A last resort would be a colectomy while alcohol abstinence would prevent recurrences. Our case highlights the importance of maintaining a broad differential when approaching patients with similar cases, as they can present with a variety of non-specific symptoms and can lead to severe, life-threatening complications that ultimately compromise the patient’s prognosis and quality of life.</p>