Paralytic ileus

^^ ^I^D: Functional bowel obstruction due to atony and disruption of normal peristalsis.

ZA: Post-op ileus following intra-abdominal surgery.

Metabolic: Hypokalaemia, hypomagnesaemia, ketoacidosis, uraemia, porphy-

Oria, heavy metal poisoning.

Inflammation: Response to a local inflammatory process, e.g. appendicitis. Diffuse peritonitis: Bacterial or chemical. Retroperitoneal pathology: Haematoma, pancreatitis. ^^ Drugs: Opioids, antipyschotics, anticholinergics, Parkinson's disease medica tions.

^J Neuropathic disorders: Diabetes, multiple sclerosis, scleroderma.

Ogilvie's syndrome: Colonic pseudo-obstruction, associated with long-term ^^ debility, chronic disease, immobility and polypharmacy.

^T^: Depending on aetiology but a common problem in surgical patients.

^IH Failure to open bowels, constipation. Initally, abdominal distension without pain, but later symptoms may mimic those of true obstruction. History relevant to cause, e.g. recent surgery.

E: Abdominal distension. Bowel sounds may be reduced or absent. Mild tenderness, if guarding or rebound tenderness, peritonitis should be diagnosed. There may be faecal impaction on rectal examination.

_P: Post-op paralytic ileus is related to several factors: sympathetic overactivity, the effects of handling bowel, changes in mucosal permeability, potassium depletion and peritoneal irritation by blood. Reflex paralytic ileus is thought to be due to interference with the autonomic nervous supply while peritonitis results in the toxin release and paralysis of the intrinsic nerve plexuses. Paralytic ileus may result in fluid, electrolyte and protein loss in the bowel lumen; combined with gaseous dilatation, can result in subsequent impairment of mesenteric blood supply and toxin absorption.

I: As appropriate to patient's status and aetiology. May include: Blood: FBC, U&Es, Mg2+, ESR and CRP.

Imaging: Erect CXR and AXR, CT scan: May show distension of bowel, faecal impaction. Caecal diameter > 12 cm significantly " risk of perforation. A water-soluble contrast enema may help exclude a mechanical obstruction.

M: As appropriate, depending on aetiology, approaches used include:

Conservative: Nil by mouth, NG tube if vomiting, IV fluid replacement and correction of electrolyte imbalances. If faecal impaction, may respond to enema, manual evacuation or placement of a flatus tube for decompression. Medical: Treatment of the underlying cause (e.g. infection). In the absence of mechanical obstruction, persistent paralytic ileus may respond to prokinetic agents such as metoclopramide, domperidone or erythromycin. Surgical: If the bowel is severely distended and there is danger of perforation, decompression and stoma formation may be needed.

C: Bowel perforation, most commonly caecal (40% mortality), peritonitis.

_P: Usually responds to conservative measures. Colonic psuedo-obstruction can be a chronic problem in older patients.

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Responses

  • lucas
    Is enema useful in paralytic ileus?
    2 years ago

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