The following are the signs and symptoms of paralytic ileus:

• Abdominal distention due to accumulation of fluid and gas
• Constipation
• Diarrhea
• Abdominal bloating
• Vomiting
• Inability to pass gas
• Abdominal pain
• Abdominal cramps
• Breath odor

• Fever

  He didn’t feel any fever, and he didn’t experienced pain nor bloody in his urine. 3 days before commotion, his stomach getting bigger and getting more filled up. He still experience the abdominal discomfort. [authorstream.com]

  It is characterized by obstipation, severe abdominal pain, vomiting and fever. General status of the patient is very severe, dehydration often occurs, and abdomen is sensitive even to gentle palpation. [oxy.hr]

  However, two days later, her general condition worsened with aplasia (PMN 130/mmc), severe abdominal pain, distension, hyponatremia and fever. Therapy with G-CSF was started. [ncbi.nlm.nih.gov]

  […] is the cause): Abdominal guarding (increased abdominal muscular tone, which intensifies on slight pressure), pain when attempting to cough, rebound tenderness (pain upon removal of pressure greater than upon application of pressure), and frequently fever [empendium.com]

  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]

• Acutely Ill Patient

  Films taken in the upright position (standing or sitting in acutely ill patients) or when lying on the side (the most sensitive view) may demonstrate free intraperitoneal air, which is evidence of GI perforation (Figure 6.1-16). [empendium.com]

• Malaise

  The patient then developed malaise, nausea, left lower quadrant pain, and purulent drainage from the ileostomy, and had poor oral intake. [nursingcenter.com]

• Abdominal Pain

  He experienced the abdominal pain and intermittent. Patient experienced the abdominal discomfort in every regio in his stomach. [authorstream.com]

  Interventions • Interventions Notify surgeon of changes in: o VS o Bowel sounds o Decreased urine output o Increased abdominal distention o Pain Maintain strict I&O record Monitor for signs of dehydration and electrolyte imbalance Assess pain and provide [slideshare.net]

  Described is a case in which a patient presented with chest and abdominal pain after methamphetamine use. The patient was ultimately diagnosed with a methamphetamine-induced paralytic ileus. [ncbi.nlm.nih.gov]

• 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]

  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]

  Presentation Prolonged hospitalization, electrolyte imbalance, painful abdominal distension Patient Data Age: 70 years Gender: Male Loading images... Marked distension of bowel loops with air-fluid levels. No evidence of mechanical obstruction. [radiopaedia.org]

• Absent Bowel Sounds

  […] occur) Absent bowel sounds or high pitched bowel sounds above obstruction (upon auscultation) Temperature > 100° (rare occurrence, secondary to strangulation or peritonitis occurring) 6. [slideshare.net]

  Obstipation or constipation Abdominal distention High-pitched, tinkling bowel sounds (early) Absent bowel sounds (late) Diffuse, continuous abdominal pain Vomiting Obstipation or constipation Marked abdominal distention Tympany on percussion Absent bowel [amboss.com]

  Common presenting features therefore are: Failure to pass flatus or faeces Sensation of bloating and distention Nausea and vomiting/ high NG output On examination, there will be abdominal distention and absent bowel sounds (whereas in mechanical obstruction [teachmesurgery.com]

  His abdomen was distended and tympanic with absent bowel sounds. There were no signs of peritonism or herniae. Rectal examination revealed a collapsed rectum with no masses. [hindawi.com]

  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

  […] is carried out to analyze the abdominal tenderness and bloating. [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]

  Abdominal Bloating The failure to defecate and pass gas leads to bloating of the abdomen. Vomiting Intestinal obstruction commonly leads to vomiting. Excessive Belching The inability to pass gas forces the sufferer to belch every now and then. [primehealthchannel.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]

  bowel sounds Extremity Examination: Extremity Examination Warm acrals Oedema - - - - - - - - LABORATORY FINDING may, 21, 2012 : LABORATORY FINDING may, 21, 2012 Blood Results Normal Hb 1 4 .3 12-14 g/dl Ht 43 37-43 % Tromb ocyte 150.000 150.000-450.000 [authorstream.com]

  Clinical features Signs of Ileus in the ICU patient can include abdominal distention, intolerance to enteral feeds, increased gastric output, increase in abdominal pressure, decreased flatus, decreased bowel sounds and decreased stool output. [cancertherapyadvisor.com]

• Xerostomia

  First flatus time and xerostomia associated with gum-chewing after liver resection. J Clin Nurs. 2012;21(15–16):2188–2192. 4. Marwah S, Singla S, Tinna P. [journals.lww.com]

• Jaundice

  Complications may include or may lead to: Electrolyte (blood chemical and mineral) imbalances Dehydration Hole (perforation) in the intestine Infection Jaundice (yellowing of the skin and eyes) If the obstruction blocks the blood supply to the intestine [medlineplus.gov]

  Infection Jaundice Perforation in the intestine Necrotizing enterocolitis Tissue death Gangrene 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. [symptoma.com]

  Left untreated, ileus can lead to infection, jaundice, electrolyte imbalance and perforation of the intestine. Abdominal or spinal surgery may cause ileus. Other causes include trauma or injury, infection and electrolyte imbalance. [livestrong.com]

• Fracture

  Ileus sometimes occurs in association with renal or thoracic disease (eg, lower rib fractures, lower lobe pneumonias, MI). Gastric and colonic motility disturbances after abdominal surgery are common. [youtube.com]

  Paralytic ileus may also be caused by peritonitis; ischemia or surgical manipulation of the bowel; retroperitoneal hemorrhage; spinal fracture; systemic sepsis; shock; hypokalemia; uremia; pharmacologic agents (eg, vincristine, loperamide, and calcium [patientcareonline.com]

  J Arthroplasty 2004;19(7, suppl 2):82–86 7., , : Prolonged ileus after severe pelvic fracture. [journals.lww.com]

  […] especially those associated with fractured vertebrae; or any severe metabolic disease. [medical-dictionary.thefreedictionary.com]

• Sweating

  Pagina 64 - Arsenicum when the different stages are not distinctly marked, but the chilliness, heat and sweat occur simultaneously, or when there are frequent changes from chilliness to heat, and vice versa; or internal chilliness with external heat; [books.google.ro]

  Patients with secretory tumors experience paroxysmal episodic hypertension, as well as the typical triad of symptoms associated with pheochromocytomas, for example, palpitations, headache and sweating. [jmedicalcasereports.biomedcentral.com]

  It caused me to jump out of bed and my entire body was sweating. I walked around for a few minutes and waited for the pain to subside and got back into bed. I can no longer lie on my left side due to the pain. [healingwell.com]

• Lacrimation

  Safety events evaluated were cardiac arrest, bradycardia, bronchospasm requiring intervention, nausea requiring intervention, or severe salivation, lacrimation, or diarrhea. RESULTS: A total of 182 patients were eligible for inclusion. [ncbi.nlm.nih.gov]

• Fear

  By JEN GUNTER Photo Credit iStock Doctors Treating a Patient With a Nightmarish Condition She had lost all of her skin and I feared I had helped make her last weeks an unrelenting horror show, until our chance reunion. By ALESSANDRA COLAIANNI, M.D. [nytimes.com]

  In the past, it was often feared that the pharmacological suppression of pain might mask the clinical manifestations of an acute abdomen and impede diagnosis, but modern CT imaging has eliminated this concern. [ncbi.nlm.nih.gov]

• Lethargy

  In the months prior to admission, he had complained of constipation, lethargy, coarse skin and family members had noticed mental slowing, hoarse voice and changes in facial appearance. [thyroidresearchjournal.biomedcentral.com]

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.

• Bowel Distention

  Paralytic ileus typically presents with abdominal distention and minimal pain, which intensifies with increasing distention. Bowel sounds are generally minimal or absent. [patientcareonline.com]

  Obstipation or constipation Abdominal distention High-pitched, tinkling bowel sounds (early) Absent bowel sounds (late) Diffuse, continuous abdominal pain Vomiting Obstipation or constipation Marked abdominal distention Tympany on percussion Absent bowel [amboss.com]

  Clinically, the abdomen may be distended and tympanic, depending on the degree of abdominal and bowel distention, and may be tender. [gmjournal.co.uk]

  It is characterized by bowel distention, lack of bowel sounds, accumulation of GI gas and fluid, and delayed passage of flatus and stool ( TABLE 1 ). 1 The reported incidence of POI ranges from 4% to 32%. 2,3 A higher incidence is associated with abdominal [uspharmacist.com]

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 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.

• Infection
• Jaundice
• Perforation in the intestine
• Necrotizing enterocolitis
• Tissue death
• Gangrene 

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:

• Gastroenteritis 
• Pancreatitis 
• Complications as a result of surgical procedures [2].
• Obstruction of the mesenteric nerve which is responsible for supplying blood to the abdomen (mesenteric ischemia). 
• Appendicitis
• Electrolyte imbalances
• Drugs containing opioids and narcotics often slow down the peristalsis movement of the intestine.
• Disorders of the lung or kidney

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.

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.

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].

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.

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.

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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.
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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.