Paralytic ileus is a condition characterized by the symptoms of abdominal bowel obstruction like nausea, vomiting, and vague abdominal discomfort due to neuromuscular failure, metabolic disturbance, and post abdominal surgery. Diagnosis is based on x-ray findings and clinical findings.

What causes the paralytic ileus?

1. Postoperative: ileus usually occurs after any abdominal procedure.
2. Infection: intra-abdominal sepsis may cause ileus.
3. Reflux ileus: due to facture spine or ribs, retroperitoneal hemorrhage.
4. Metabolic disturbance: hypokalemia, uremia are the most common contributory factors.

Sign and symptoms of paralytic ileus.

Irrespective of the cause ,paralytic ileus has the sign and symptoms of bowel obstruction which includes:

1. Abdominal distension
2. Vague abdominal discomfort and generalized abdominal pain.
3. Nausea and vomiting
4. No bowel sound during auscultation
5. No passage of stool and flatus.

Diagnosis of Paralytic ileus

Diagnosis relies on patient history and physical examination. Abdominal x-ray, Ultrasound or CT, blood tests and serum electrolyte confirm the diagnosis.

How to managed paralytic ileus?

The essence of treatment is prevention, with the use of nasogastic tube and restriction of oral intake until bowel sound and passage of flatus return. Electrolyte must be substituted. Patients with intra abdominal sepsis are managed with giving broad spectrum antibiotics.

Early introduction of fluids and solids is, however, becoming popular.

Specific treatment is directed towards the cause, but the following general principle applies:

• The primary cause must be removed.
• Gastrointestinal distension must be relieved by decompression
• Close attention to fluid and electrolyte balance is mostly required.
• There is no role for the routine use of peristaltic stimulants
• If paralytic ileus is prolonged and threatens life, a laparotomy should be considered to exclude a hidden cause and facilitate bowel decompression.

References:

• Sabiston textbook of surgery 18th edition
• Bailey and love, surgery 25th edition
• The Washington manual of surgery, 5th edition.
• emedicine.medscape.com

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Intestinal pseudoobstruction is characterized by symptoms of intestinal intestine obstruction in the absence of a mechanical obstruction. The mechanisms for controlling orderly propulsive motility fail while the intestinal lumen is free form obstruction. This syndrome may result from abnormalities of the muscles of ENS. In general symptoms of colicky abdominal pain, nausea and vomiting, and abdominal distension simulate mechanical obstruction.Pseudoobstruction may be associated with degenerative changes is the ENS. Failure of propulsive motility reflects the loss of the neural networks that program and control the organized motility patterns of the intestine. This disorder can occur in varying lengths of intestine of in the entire length of the small intestine. Contractile behavior of the of the circular muscle is hyperactive but disorganized in the denervated segments. The behavior reflects the absence of inhibitory nervous control of the muscles, which are self-excitable when, released form the braking action of enteric inhibitory neurons.

Another form of pseudoobstruction is paralytic ileus characterized by prolonged motor inhibition .The electrical slow waves are normal but muscular action potentials and contractions are absent. Prolonged ileus commonly occurs after abdominal surgery. The illus. results form suppression of the synaptic circuits that organize propulsive motility in the intestine. A probable mechanism is presynaptic inhibition and the closure of the synaptic gates.Continuous discharge of the inhibitory motor neurons accompanies suppression of the motor circuits. This activity of the inhibitory motor neurons prevents the circular muscle form responding to electrical slow waves, which are undisturbed in ileus.

References:

1. Short practice of surgery, bailey and love, 25th edi.
2. Harrison’s Principles of Internal Medicine, 17th edition.
3. Davidson’s Principles and Practice of Medicine, 20th Edition
4. The Washington Manual of surgery, 5th edition.
5. Medical physiology, Lippincott Williams & Wilkins 3rd edi.

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