A paralytic ileus is an intestinal obstruction due to a paralysis of the intestinal musculature. So the intestinal contents can not be transported further. For example, a paralytic bowel obstruction can occur following an appendectomy when the bowel arrives as a reflex to the procedure. What further causes are possible and how a paralytic ileus is expressed and treated, you will find out here!
Paralytic ileus: causes
A paralytic ileus (intestinal paralysis) can have a variety of causes. Sometimes it is Closure of an intestinal vessel by a blood clot behind it. The clot may have arisen directly on site in the blood vessel concerned (thrombus) or be swollen from elsewhere with the bloodstream (embolus). When the clot closes the vessel completely, the intestinal tissue that is actually supplied by this vessel, no longer receives oxygen and nutrients – it dies away (necrosis). Doctors refer to the event as a mesenteric infarction.
In other cases, a paralytic ileus arises as a reflex after abdominal surgery occur. The operation triggers mechanical stimuli, halting bowel movement (postoperative ileus). Also at one Biliary or renal colic or Spinal cord injury a paralytic ileus may appear reflexively.
Severe abdominal disorders such as peritonitis, appendicitis or pancreatitis may also lead to paralytic ileus. Conversely, in advanced paralytic ileus, gut bacteria can break through the intestinal wall and enter the abdominal cavity – resulting in peritonitis. Also, inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis may be the cause of a paralytic ileus.
Furthermore, certain drugs cause intestinal paralysis. These include, for example, strong analgesics from the group of opiates, Parkinson’s drugs, antidepressants and anticonvulsant drugs (spasmolytics). Also, the abuse of laxatives (laxatives) can trigger a paralytic ileus in the worst case.
Disorders of the electrolyte balance are also possible causes. For example, potassium deficiency (hypokalaemia) and ketoacidotic coma (severe complication of diabetes mellitus) can lead to intestinal arrest.
In some patients, the paralytic ileus can be on a uremia traced. This refers to an accumulation of urine-containing substances in the blood (uremia) due to impaired kidney function. Other possible causes of intestinal paralysis are hypothyroidism (Hypothyroidism) as well Injuries in the abdomen.
Note: Sometimes a paralytic ileus develops from a mechanical ileus (ie from a bowel obstruction due to a mechanical obstruction).
Paralytic ileus: symptoms
Paralytic ileus lacks any signs of bowel movement. The doctor can self with the stethoscope no or hardly intestinal noises hear (such sounds usually indicate a normal intestinal activity).
The stomach is initially strong in a intestinal paralysis bloated, In the further course, it can become tense and hard (drum belly). Neither chair nor winds can go away (Chair and wind behavior).
hiccup, nausea, Vomit such as Pain in the abdominal area are other common symptoms.
Paralytic ileus: examinations and diagnosis
Physical examination and x-rays are the most important steps to diagnose a paralytic ileus:
In the physical examination The abdomen is thoroughly tapped with the stethoscope. If no bowel sounds are heard in all abdominal regions, there is an urgent suspicion of a paralytic ileus. Doctors refer to this as a “tomb silence” in the abdomen. If bowel sounds are audible, this excludes a paralytic bowel obstruction.
The X-ray photograph is made while standing or with half-erect upper body. One typically sees standing fluid levels and strongly stretched and distended intestinal sections in the X-ray image.
Paralytic ileus: treatment
Patients with a paralytic ileus (or other form of intestinal obstruction) may initially do not eat or drink anymoreuntil the bowel has recovered through therapy. Over a infusion those affected receive the necessary fluids and nutrients. Also, this way drugs be administered. These are above all agents that stimulate the intestinal movement (peristalsis). You can get the paralyzed intestine going again. If needed, patients may also be given other medications such as pain relievers or nausea and vomiting medications.
In addition, a feeding tube placed to derive congested stomach and intestinal contents. Also a rectal enema is performed so that the intestine can empty.
In addition, it is important to eliminate the cause of intestinal paralysis. For example, a hypothyroidism or a severe metabolic imbalance in diabetics as a trigger of paralytic ileus must be treated accordingly.
With such conservative measures usually suffice to correct a intestinal paralysis. However, an operation may be necessary if there is a paralytic ileus developed from a mechanical intestinal obstruction or there is peritonitis.