Paresis of the intestine (ileus)

Paresis of the intestine (paralytic intestinal obstruction, adynamic intestinal obstruction, ileus) is a temporary disturbance of intestinal motility.

This disorder is usually observed after operations on the abdominal cavity, especially after operations on the intestines. Symptoms of intestinal paresis are nausea, vomiting, and unspecified abdominal discomfort. Diagnosis of intestinal paresis is based on x-ray data and clinical examination. Treatment of intestinal paresis is favorable and consists of nasogastric sounding, aspiration and intravenous infusion therapy.

[1], [2], [3]

Causes of the intestinal paresis

In addition to post-operative reasons intestinal paresis (ileus) may be the result of intra-abdominal or retroperitoneal inflammatory processes (eg., Appendicitis, diverticulitis, perforation of a duodenal ulcer), retroperitoneal or intraabdominal hematomas (eg., Rupture of aneurysm of the abdominal aorta, a compression fracture of the spine), metabolic disorders (eg, hypokalemia) or medication effects (eg, opiates, anticholinergics, sometimes Ca channel blockers).

Paresis of the intestine (ileus) sometimes develops in diseases of the kidneys or chest organs (eg, rib fractures below the VI-VII ribs, lower lobe pneumonia, myocardial infarction).

Characterized by disorders of motility of the stomach and colon after abdominal surgery. The function of the small intestine is usually impaired least of all; her motility and absorption are restored to normal within a few hours after surgery. The evacuation function of the stomach is usually impaired to approximately 24 hours or more; the function of the colon suffers the most and its recovery may be delayed up to 48-72 hours or more.

[4], [5], [6], [7]

Symptoms of the intestinal paresis

Symptoms of intestinal paresis include bloating, vomiting and a feeling of indefinite discomfort. Pain rarely has a classic colicky character, as with mechanical obstruction. Stool retention or discharge of small amounts of watery feces may occur.

During auscultation of peristalsis is absent or minimal intestinal noise is heard. The stomach is not tense unless the underlying cause is inflammatory etiology.

[8], [9]

Diagnostics of the intestinal paresis

The most important task is the differential diagnosis of ileus from intestinal obstruction. In both cases, the radiographs visualize the accumulation of gas in the bloated individual loops of the intestine.

However, with postoperative obstruction, gas can accumulate to a greater extent in the colon than in the small intestine. The accumulation of gas in the small intestine in the postoperative period may indicate the development of complications (eg, obturation, peritonitis).

In other types of intestinal obstruction, radiological findings are similar to obstructive obstruction; Differential diagnosis of intestinal paresis may be difficult if the clinical data clearly do not indicate a particular type of  intestinal obstruction.

X-ray examinations with a water-soluble contrast agent can help in differential diagnosis.

[10], [11]

Treatment of the intestinal paresis

Treatment of intestinal paresis involves constant nasogastric aspiration, complete elimination of oral food and fluid intake, IV transfusion of fluids and electrolytes, minimal prescribing of sedatives and elimination of the use of opiates and anticholinergic drugs.

Especially important is maintaining an adequate serum K level [> 4 meq / l (> 4 mmol / l)]. Persistent ileus for more than 1 week, most likely, has a mechanical obstructive cause, therefore, the indications for laparotomy should be considered.

Sometimes colonic intestinal paresis (ileus) may be weakened by colonoscopic decompression; seldom there is a need for a cecostomy.

Colonoscopic decompression is sometimes effective in treating pseudo-obstruction (Ogilvy syndrome), which is associated with natural bowel bending in the splenic angle, although no reason for the retention of gas and feces during irrigoscopy or colonoscopy is detected.