Paralytic ileus - GI presentations

Paralytic ileus

Definition

A cessation of the peristaltic movement of the gastrointestinal tract causing a form of intestinal obstruction.

Aetiology/pathophysiology

Causes of paralytic ileus include abdominal surgery, peritonitis, pancreatitis, metabolic disturbance (including hypokalaemia) or retroperitoneal bleeding. Inflammation of the serosal surface of the small bowel causes paralysis of gut motility leading to dilation. Fluid accumulation within the lumen of the bowel may result in fluid and electrolyte imbalances. This may further exacerbate the paralytic ileus.

Clinical features

There is abdominal distension with little evidence of rebound or guarding. If patients are not nil by mouth they develop copious vomiting. Patients do not pass stool or flatus and bowel sounds are characteristically absent.

Investigations

Abdominal X-ray shows gaseous distension with multiple fluid levels in the lumen of the bowel. This may be optimally seen on an erect film.

Management

It is treated conservatively with i.v. fluids and nasogastric tube (drip and suck). Fluid and electrolyte imbalances should be corrected. Any underlying cause should be identified and treated.