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Paralytic Ileus


Presentation

The following are the signs and symptoms of paralytic ileus:

Antipsychotic Agent
Abdominal Distension
  • She presented with remarkable abdominal distension and respiratory difficulty but was effectively treated by surgical removal of the tumor with preoperative and operative management using alpha and beta adrenergic blocking agents.[ncbi.nlm.nih.gov]
  • Two days after admission the child presented vomiting, abdominal distension, meteorism and increase of scrotal swelling with edema.[ncbi.nlm.nih.gov]
  • Among the infants admitted to our gastrointestinal unit with a history of acute diarrhoea, 35% developed abdominal distension and 12% developed the full clinical picture of paralytic ileus.[ncbi.nlm.nih.gov]
  • As magnesium blood level fell from 5.1 mg/dl on admission to 2.4 mg/dl on day 3, the vomiting, obstipation, and abdominal distension resolved.[ncbi.nlm.nih.gov]
  • 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.[europeanmedical.info]
Absent Bowel Sounds
  • bowel sounds or high pitched bowel sounds above obstruction (upon auscultation) Temperature 100 (rare occurrence, secondary to strangulation or peritonitis occurring) 6.[slideshare.net]
  • While in the surgical unit, he developed progressive abdominal distension and absent bowel sounds. His urine output progressively declined and the serum creatinine was rising.[thyroidresearchjournal.biomedcentral.com]
Abdominal Bloating
  • The patient may also experience abdominal bloating and distention followed by severe pain. Other symptoms include dehydration, diarrhea, constipation, electrolyte imbalance, inability to pass gas and breathe odor.[symptoma.com]
  • Some of the common symptoms can include: Abdominal bloating, swelling, or distension. Constipation Diarrhea Foul smelling breath Gs Having no bowel sounds Nausea that may or may not include vomiting.[hellomrdoctor.com]
  • The symptoms of ileus are abdominal bloating caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and cramps. People may pass watery stool.[msdmanuals.com]
Decreased Bowel Sounds
  • Surgery, peritonitis, electrolyte abnormalities, medications, severe medical illness Nausea, vomiting, obstipation, distention Minimal abdominal tenderness, decreased bowel sounds Other imaging to distinguish from partial small bowel obstruction Limited[quizlet.com]
  • Additional symptoms that may accompany the condition are nausea, abdominal distention, vomiting, decreased bowel sounds, and also a mild level of tenderness over the abdomen.[constipation-remedies.co.uk]
Encephalopathy
  • This report describes a child having the syndrome of overlapping phenotypic features of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) and mitochondrial neurogastrointestinal encephalopathy syndrome (MNGIE).[ncbi.nlm.nih.gov]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Mydriasis
  • Abstract Cyclopentolate-phenylephrine eye drops are commonly used for mydriasis during routine screening for retinopathy of prematurity in preterm infants. Although systemic absorption is minimal, it can result in side effects.[ncbi.nlm.nih.gov]

Workup

A physical examination is carried out to analyze the abdominal tenderness and bloating. Blood work would show dehydration, electrolyte imbalance and infection.

An abdominal x-ray would also be required to analyze the nature of the obstruction. A serial abdominal x-ray with dyes may demonstrate the progression of ileus recovery in post-operative patients [5]. In addition, CT scan of the abdomen would also be done. A diagnostic procedure known as upper GI and small bowel series is a type of x-ray that is done to study the internal features of the abdomen. In this test, the patient is given barium milkshake to drink prior to the procedure. When the contrast media stays more than 4 hours in a bowel region, this is already suggestive of an obstructive process [6]. Going forward an x-ray of the abdomen will be done.

Treatment

Treatment of paralytic ileus is largely dependent on relieving the underlying causative factors. This would help resolve the condition in some days. Primary management care is focused on correcting electrolyte imbalances and dehydration. Intravenous hydration is administered to replenish for the lost fluids. In addition, a tube may be required to be inserted through the nasal route to relieve the symptoms of distention and vomiting.

If the above supportive treatment regime fails to show any effect then medications are prescribed to facilitate peristalsis. Current studies have identified the drug alvimopan to hasten bowel peristalsis in postoperative patients [7]. If there are signs of tissue death then surgery may be required.

Prognosis

Prognosis of the condition depends on the severity of the disease. Usually with prompt diagnosis and treatment, the prognosis is expected to be good. Paralytic ileus is a temporary phenomenon and gets resolved with proper treatment. Other abdominal surgery like laparoscopic resection of the colon may have a short lived ileus compared to the rectal surgery which may have an extended ileus consequently affects morbidity rate and duration of hospital sate [4].

Complications

Paralytic ileus inhibits the ability of the intestines to absorb nutrients from the food and also does not allow the passage of digested food through the digestive system. Thus, electrolyte imbalance and dehydration are some of the notable complications of paralytic ileus. In addition, this condition can also bring along the following complications if treatment is not initiated on time.

Etiology

Paralytic ileus is not caused due to any kind of physical obstruction. It is purely the result of malfunctioning of the intestinal muscles and nerves. As a result of the malfunctioning, the normal process of digestion, absorption and elimination does not take place calling for an emergency situation. The causes of paralytic ileus are described as below:

Epidemiology

Statistics reveal that about 50% of patients undergoing abdominal surgery suffer from paralytic ileus as a secondary complication to the surgical procedure [3]. It is a common condition for patients undergoing any kind of abdominal surgical procedure. It has also been estimated that, paralytic ileus is the main cause of intestinal obstruction in children and infants.

Sex distribution
Age distribution

Pathophysiology

Under normal circumstances, the food that is digested in the stomach passes through the intestine where the nutrients are absorbed. In condition of paralytic ileus, the muscles and nerves of the intestine get paralyzed. When such a condition takes place, the nutrients from the food are not absorbed and the passage of fluid and food through the digestive tract is disrupted. This causes an accumulation of fluid and gas.

Prevention

In many cases, development of paralytic ileus cannot be prevented. Conditions such as hernias and tumors should be promptly treated. It is also necessary to avoid medications such as opiates like morphine which are known to promote development of ileus [8]. The thoracic epidural administration option with combined local anesthetics during abdominal surgery may shorten the course of the ileus postoperatively [9]. The administration of preoperative celcoxib in patients have significantly prevented post-operative ileus compared to other non-steroidal anti-inflammatory drugs (NSAIDs) [10].

Summary

Paralytic ileus is a condition characterized by hypomotility of the intestine. Such a condition does not result from any kind of physical obstruction; but occurs due to malfunctioning of the nerves and muscles of the intestine. This condition is also known as pseudoobstruction and is a common compliant amongst children and infants.

Physiologic ileus resolves within 2 to 3 days; thus, ileus persisting beyond 3 days are already considered adynamic or paralytic etiologically [1]. Paralytic ileus is an emergency and should receive prompt treatment to avoid serious complications going forward. This condition hinders with the absorption of the nutrients from the food that is digested. Due to malfunctioning of the intestine, the nutrients are not absorbed and the residue does not pass through the system causing buildup of fluid and gas in the stomach.

Patient Information

Definition 

Paralytic ileus also known as pseudoobstruction is a disorder characterized by malfunctioning of the muscles and nerves of the intestine. In this condition, there is no mechanical obstruction. Paralytic ileus is most common cause of intestinal obstruction in children and infants. Such a condition hinders the passage of food through the intestine.

Cause

Causes of paralytic ileus include intestinal infections due to bacteria or fungi, mineral imbalances, postoperative complications, lung disease, kidney disorders, mesenteric ischemia, certain medications and appendicitis.

Symptoms

Symptoms of paralytic ileus begin with vomiting and dehydration. The patient may also experience abdominal bloating and distention followed by severe pain. Other symptoms include dehydration, diarrhea, constipation, electrolyte imbalance, inability to pass gas and breathe odor.

Diagnosis

A physical examination of the abdomen would reveal distention and fullness. In addition, imaging studies such as CT scan would be done to reveal the nature of the obstruction. X-ray of the abdomen using barium milkshake would help in examination of the internal structures. Blood tests are required to determine electrolyte imbalance and dehydration.

Treatment

The primary goal of treating paralytic ileus is to correct the underlying cause of the condition. Once this is achieved then the ileus resolves by itself. In addition to this, several methods to relieve symptoms are employed. Administration of intravenous fluids is done to replenish the lost fluids through vomiting and diarrhea. A tube is also inserted through the nasal route to relieve the distention. Medications may also be required to ensure the muscles of the intestine work.

References

Article

  1. Livingston EH, Passaro EP Jr. Postoperative ileus. Dig Dis Sci. Jan 1990; 35(1):121-32.
  2. Shibata Y, Toyoda S, Nimura Y, Miyati M. Patterns of intestinal motility recovery during the early stage following abdominal surgery: clinical and manometric study. World J Surg. Oct 1997; 21(8):806-9; discussion 809-10.
  3. Senagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health Syst Pharm. Oct 15 2007; 64(20 Suppl 13):S3-7.
  4. Vasquez W, Hernandez AV, Garcia-Sabrido JL. Is gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis of randomized clinical trials. J Gastrointest Surg. Apr 2009; 13(4):649-56.
  5. Tollesson PO, Cassuto J, Rimback G. Patterns of propulsive motility in the human colon after abdominal operations. Eur J Surg. Apr 1992; 158(4):233-6.
  6. Schwartz SI, ed. Principles of Surgery. 7th Ed. New York, NY: McGraw-Hill; 1999
  7. Taguchi A, Sharma N, Saleem RM, et al. Selective postoperative inhibition of gastrointestinal opioid receptors. N Engl J Med. Sep 27 2001; 345(13):935-40.
  8. Cali RL, Meade PG, Swanson MS, Freeman C. Effect of Morphine and incision length on bowel function after colectomy. Dis Colon Rectum. Feb 2000; 43(2):163-8.
  9. Zingg U, Miskovic D, Hamel CT, Erni L, Oertli D, Metzger U. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: Benefit with epidural analgesia.Surg Endosc. Feb 2009; 23(2):276-82.
  10. Wattchow DA, De Fontgalland D, Bampton PA, Leach PL, and McLaughlin K, Costa M. Clinical trial: the impact of cyclooxygenase inhibitors on gastrointestinal recovery after major surgery - a randomized double blind controlled trial of celecoxib or diclofenac vs. placebo. Aliment Pharmacol Ther. Nov 15 2009; 30(10):987-98.

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Last updated: 2019-07-11 21:53