BACKGROUND Intestinal pseudo-obstruction is a syndrome characterized by recurrent signs and symptoms of intestinal pseudo-obstruction or dilation without any evidence of mechanical pseudo-obstruction. Its cause is unknown, and it is associated with severe alterations of gastrointestinal motility. OBJECTIVE To report the transendoscopic treatment in a case of intestinal pseudo-obstruction as an alternative to a poor response to medical treatment. METHODS The diagnosis of intestinal pseudo-obstruction was made in a 34-year old male patient who had not responded to conservative treatment; therefore, a colonoscopy was performed and an ileal drainage was introduced with its distal end 50 cm beyond the ileocecal valve. RESULTS Twenty-four hours after the procedure was performed clinical and radiological improvement was evident. Such improvement was completed at 72 hours when the patient tolerated oral ingestion. CONCLUSIONS Transrectal ileal drainage could be an alternative to consider in those patients that do not respond to conservative treatment.