Paralytic Ileus

Overview

Paralytic ileus is a state in which there is failure of transmission of peristaltic waves secondary to neuromuscular failure (e.g. in the myenteric, Auerbach's and submucous, Meissner's plexuses). The resultant stasis leads to accumulation of fluid and gas within the bowel, with associated distension, vomiting and absence of bowel sounds and obstipation.

Signs and Symptoms

Abdominal distension, Tympanic on percussion, Vomiting, No passage of stool or flatus, No bowel sounds on auscultation

Common Causes

Gastroenteritis, Chemical and electrolytes imbalance, Abdominal surgery, Decreased blood supply to the intestines, Infections inside the abdomen

Risk Factors

Usually follows after an abdominal surgery, Intra-abdominal sepsis, Reflex ileus follows after fracture of the spine or ribs, retroperitoneal hemorrhage, Uraemia and hypokalemia are the most common contributory factors

Investigation Techniques

Physical examination, Full blood count, Serum electrolytes, Abdominal X-ray, Abdominal ultrasound

Treatment and Prevention

Gastrointestinal distension must be decompressed- Nasogastric tubes/suction to decompress the stomach, Restriction of oral intake until bowel sounds and passage of flatus returns, Electrolytes balance must be maintained, Enhanced recovery programme with early introduction of fluids and solids, Rarely, peristaltic stimulants like domperidone or erythromycin needed unless in resistant case, The need of laparotomy becomes increasingly likely the longer the bowel inactivity persists