Paralytic ileus (Adynamic bowel obstruction)

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Paralytic ileus is a condition characterized by the symptoms of abdominal bowel obstruction like nausea, vomiting, and vague abdominal discomfort due to neuromuscular failure, metabolic disturbance, and post abdominal surgery. Diagnosis is based on x-ray findings and clinical findings.

What causes the paralytic ileus?

1. Postoperative: ileus usually occurs after any abdominal procedure.

2. Infection: intra-abdominal sepsis may cause ileus.

3. Reflux ileus: due to facture spine or ribs, retroperitoneal hemorrhage.

4. Metabolic disturbance: hypokalemia, uremia are the most common contributory factors.

Sign and symptoms of paralytic ileus.

Irrespective of the cause ,paralytic ileus has the sign and symptoms of bowel obstruction which includes:

  1. Abdominal distension
  2. Vague abdominal discomfort and generalized abdominal pain.
  3. Nausea and vomiting
  4. No bowel sound during auscultation
  5. No passage of stool and flatus.

Diagnosis of Paralytic ileus

Diagnosis relies on patient history and physical examination. Abdominal x-ray, Ultrasound or CT, blood tests and serum electrolyte confirm the diagnosis.

How to managed paralytic ileus?

The essence of treatment is prevention, with the use of nasogastic tube and restriction of oral intake until bowel sound and passage of flatus return. Electrolyte must be substituted. Patients with intra abdominal sepsis are managed with giving broad spectrum antibiotics.

Early introduction of fluids and solids is, however, becoming popular.

Specific treatment is directed towards the cause, but the following general principle applies:

  • The primary cause must be removed.
  • Gastrointestinal distension must be relieved by decompression
  • Close attention to fluid and electrolyte balance is mostly required.
  • There is no role for the routine use of peristaltic stimulants
  • If paralytic ileus is prolonged and threatens life, a laparotomy should be considered to exclude a hidden cause and facilitate bowel decompression.

References:

  • Sabiston textbook of surgery 18th edition
  • Bailey and love, surgery 25th edition
  • The Washington manual of surgery, 5th edition.
  • emedicine.medscape.com

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