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Paralytic ileus

PJan 16 05

Alternative names
Intestinal obstruction; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal

Definition
Intestinal obstruction involves a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.

Causes, incidence, and risk factors

Obstruction of the bowel may be caused by ileus - in which the bowel doesn’t function correctly but there is no “mechanical” (anatomic) problem - or by mechanical causes. Paralytic ileus, also called pseudo-obstruction, is one of the major causes of obstruction in infants and children.

The causes of paralytic ileus may include the following:

     
  • Medications, especially narcotics  
  • Intraperitoneal infection  
  • Mesenteric ischemia (decreased blood supply to the support structures in the abdomen)  
  • Injury to the abdominal blood supply  
  • Complications of intra-abdominal surgery  
  • Kidney or thoracic disease  
  • Metabolic disturbances (such as decreased potassium levels)

Paralytic ileus may lead to complications causing jaundice and electrolyte imbalances. In the newborn, paralytic ileus that is associated with destruction of the bowel wall (necrotizing enterocolitis) is life-threatening and may lead to infection in the infant’s blood and lungs.

In older children, gastroenteritis may be a cause of paralytic ileus, which is sometimes associated with peritonitis and a ruptured appendix.

Paralytic ileus is marked by abdominal distention, absent bowel sounds (no noise heard when listening to abdomen) and relatively little pain (as compared to mechanical obstruction).

Mechanical obstruction occurs when movement of material through the intestines is physically blocked. The mechanical causes of obstruction are numerous and may include the following:

     
  • Hernias  
  • Postoperative adhesions or scar tissue  
  • Impacted feces (stool)  
  • Gallstones  
  • Tumors blocking the intestines  
  • Granulomatous processes (abnormal tissue growth)  
  • Intussusception  
  • Volvulus (twisted intestine)  
  • Foreign bodies (ingested materials that obstruct the intestines)

If the obstruction blocks the blood supply to the intestine, the tissue may die, causing infection and gangrene. Risk factors for tissue death include intestinal malignancy, Crohn’s disease, hernia, and previous abdominal surgery.

Symptoms

     
  • Abdominal fullness, gaseous  
  • Abdominal distention  
  • Abdominal pain and cramping  
  • Vomiting  
  • Failure to pass gas or stool (constipation)  
  • Diarrhea  
  • Breath odor

Signs and tests

While listening to the abdomen with a stethoscope your health care provider may hear high-pitched bowel sounds at the onset of mechanical obstruction. If the obstruction has persisted for too long or the bowel has been significantly damaged, bowel sounds decrease, eventually becoming silent.

Early paralytic ileus is marked by decreased or absent bowel sound.

Tests that show obstruction include:

     
  • Barium enema  
  • Abdominal CT scan  
  • Upper GI and small bowel series  
  • Abdominal film

Treatment
The objective of treatment is to decompress the intestine with suction, using a nasogastric (NG) tube inserted into the stomach or intestine. This will relieve abdominal distention and vomiting.

Surgery to relieve the obstruction may be necessary if decompression by NG tube does not relieve the symptoms, or if tissue death is suspected.

Expectations (prognosis)
The outcome varies with the cause of the obstruction.

Complications

     
  • Infection  
  • Gangrene of the bowel  
  • Perforation (hole) in the intestine

Calling your health care provider
Call your health care provider if persistent abdominal distention develops and you are unable to pass stool or gas, or if other symptoms of intestinal obstruction develop.

Prevention

Prevention depends on the cause. Treatment of conditions (such as tumors and hernias) that are related to obstruction may reduce the risk.

Some causes of obstruction are not preventable.

Johns Hopkins patient information

Last revised: December 7, 2007
by Mamikon Bozoyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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