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Acute paralytic ileus and its clinical implications

Constipation

Acute paralytic ileus


Ever wondered what could cause constipation without any sign of mechanical obstruction? Then it is time you get introduced to this condition. Acute paralytic ileus is not a new condition for health providers, though it may sound new for patients. Its main presenting symptom is obstipation, otherwise known as intractable constipation. Let us take a brief look at this disorder.

What causes obstruction other than worms, parasites, and tumors? The only remaining suspect could be a defect in the neural innervation of the colon. True enough, among the precipitating factors that could cause acute paralytic ileus are electrolyte abnormalities (which could interfere in neurotransmission), peritonitis (or inflammation of the peritoneum), surgery, severe medical illness such as pneumonia or other illnesses pertaining to respiratory function, and even medications that have effects on intestinal motility. All these factors can interfere with the normal passing down of stools in the gastrointestinal tract. Recognition of these possible precipitating factors should prompt a health care provider to suspect acute paralytic ileus. 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.

Symptoms of paralytic ileus include


but are not limited to:
  • moderate, diffuse abdominal discomfort
  • constipation
  • abdominal distension
  • nausea/vomiting, especially after meals
  • lack of bowel movement and/or flatulence
  • decreased bowel sounds
  • excessive belching
  • mild level of tenderness over the abdomen

  • Risk factors

  • gastrointestinal surgery or other GI (gastroenterology) procedures
  • electrolyte abnormalities (which could interfere in neurotransmission)
  • diabetic ketoacidosis (DKA)[6], and other causes of metabolic acidosis
  • hypothyroidism
  • medications that have effects on intestinal motility (e.g. opiates)
  • peritonitis (or inflammation of the peritoneum)
  • severe medical illness such as pneumonia or other illnesses pertaining to respiratory function
  • spinal cord injury (SCI), those with injury above thoracic vertebrae 5 (T5) will have hypomotility problems within the bowel



  • Most often misunderstood, ileus is a condition wherein the peristaltic movement of the intestines is lost even though there is no evidence of obstruction. This would indicate that the food channeled into the intestines will have to stay where it is until symptoms develop. It is high in incidence among hospitalized patients, perhaps due to the presence of the precipitating factors mentioned above. Oftentimes, after a surgery, it is the small intestine who gets to function normally before the rest (most frequently within hours after the surgery), then followed by the stomach which normalizes around 24-48 hours later, and the last is the colon, normalizing around 48-72 hours later. Thus, if regular passing out of stools fails to normalize on the 3rd and 4th days, then something must have gone wrong with the individual's peristaltic movements.

    A condition closely related to acute paralytic ileus is the colonic pseudo-obstruction, otherwise known as the Ogilvie's syndrome. In contrast to the acute paralytic ileus, colonic pseudo-obstruction is associated with the use of neuroleptic medications, severe metabolic illnesses, use of opiates, presence of a malignancy, and any sudden severe illness.

    Treatment of acute paralytic ileus centers more on the removal of the causative factors. Restriction of oral intake is usually employed and is gradually resumed upon return of bowel function. Electrolyte imbalances such as hypokalemia and hypercalcemia require to be corrected, since most cases of severe paralytic ileus are due to these conditions. Most importantly, if it is precipitated by a medical or surgical illness, that specific illness has to be treated in order for the bowel to revert back to its normal physiology.

    In to swimbi.com