II. Pathophysiology
- Transient intestinal dysfunction and dysmotility or paralysis of intestinal motility without a physical blockage
- May affect the Stomach, Small Bowel or colon (contrast with Small Bowel Obstruction, which presents in similar manner)
III. Causes
- Abdominal Trauma
- Abdominal surgery (i.e. laparatomy)
- Onset typically 3-5 days after surgery
- Return of function by 24 hours for Small Bowel, 48 hours for Stomach, 72 hours for colon
- Serum Electrolyte abnormality
- Hypokalemia
- Hyponatremia
- Hypomagnesemia
- Hypermagensemia
- Infectious, Inflammatory or irritation (bile, blood)
- Intrathoracic
- Pneumonia
- Lower lobe Rib Fractures
- Myocardial Infarction
- Intrapelvic (e.g. Pelvic Inflammatory Disease)
- Intraabdominal
- Intrathoracic
-
Intestinal Ischemia
- Mesenteric embolism, ischemia or thrombosis
- Skeletal injury
- Rib Fracture
- Vertebral Fracture (e.g. lumbar compression Fracture)
- Medications
IV. Risk Factors
- Advanced Age
- Prolonged bedrest
- Male gender
- Positive Fluid Balance (esp. excessive intraoperative hydration)
V. Symptoms
- Abdominal Distention
- Nausea and Vomiting are variably present
-
Generalized abdominal discomfort
- Colicky, cramping pain of Mechanical Ileus is usually absent
- Flatus and Diarrhea may still be passed
VI. Signs
- Quiet bowel sounds
- Abdominal Distention
VII. Differential Diagnosis
- Mechanical Ileus
- Bowel Pseudoobstruction
- See Ileus for diagnostic approach
VIII. Radiology: Plain Flat and Upright Abdominal XRay
- Contrast with Mechanical Ileus
- Less prominent air fluid levels
- Generalized involvement of entire GI Tract
- Air filled bowel loops tend not to be distended
IX. Radiology: Refractory ileus course
- Indicated to evaluate for Mechanical Ileus
- Upper GI series and Small Bowel follow through
- May be diagnostic and therepeutic
- Use gastrograffin instead of barium
- Barium may further obstruct bowel lumen
- Gastrograffin may stimulate bowel motility
- Decompress Stomach with Nasogastric Tube
- Instill gastrograffin via Nasogastric Tube
- CT Abdomen
X. Management
- Initial
- Limit or eliminate oral intake
- Avoid all medications that inhibit bowel motility (e.g. Anticholinergic Medications)
- Intravenous Fluid Replacement
- Correct Electrolyte abnormalities (e.g. Hypokalemia)
- Consider Nasogastric Tube placement
- Refractory Management (anecdotal evidence only)
- Consider Reglan 0.1 mg/kg/dose up to 10 mg (contraindicated in Small Bowel Obstruction)
- Consider lower bowel stimulation (e.g. Fleets Enema)
XI. Course
- Post-operative ileus resolves within 24-48 hours
XII. References
- Han (2022) Crit Dec Emerg Med 36(12): 4-10
- Torrey in Marx (2002) Rosen's Emergency Med, p. 1283-7
- Townsend (2001) Sabiston Surgery, p. 883-8
- Turnage in Feldman (1998) Sleisenger GI, p. 1799-804
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Definition (NCI_NCI-GLOSS) | A condition in which the muscles of the intestines do not allow food to pass through, resulting in a blocked intestine. Paralytic ileus may be caused by surgery, inflammation, and certain drugs. |
Definition (NCI) | An ileus caused by abdominal or pelvic surgery, infections, disorders that affect the muscles and nerves, and medications. Signs and symptoms include those of intestinal obstruction. |
Concepts | Disease or Syndrome (T047) |
MSH | D007418 |
ICD9 | 560.1 |
ICD10 | K56.0 |
SnomedCT | 155773004, 55525008 |
English | Ileus, Paralytic, Paralytic Ileus, ILEUS PARALYTIC, Ileus paralytic, Paralysis ileum, Parlaysis ileum, Paralysis intestinal, Paralysis of bowel, intestinal paralysis, adynamic ileus, bowel ileus, Ileus;paralytic, intestine paralysis, paralysis intestinal, ileus paralytic, paralytic ileus (diagnosis), paralytic ileus, Paralytic ileus, Adynamic ileus, Paralysis of intestine, Paralytic ileus (disorder), bowel; obstruction, adynamic, bowel; paralysis, ileus; adynamic, ileus; paralysis, ileus; paralytic, obstruction; bowel, adynamic, paralysis; bowel, paralysis; ileus, paralytic; ileus, adynamic; ileus, Paralysis of intestine or colon |
Dutch | paralytische ileus, immobiele ileus, paralyse ileum, paralyse van ingewanden, intestinale paralyse, adynamisch; ileus, darm; obstructie, adynamisch, darm; paralyse, ileus; adynamisch, ileus; paralyse, ileus; paralytisch, obstructie; darm, adynamisch, paralyse; darm, paralyse; ileus, paralytisch; ileus, ileus paralytisch, Paralytische ileus |
French | Iléus adynamique, Paralysie de l'iléon, Paralysie intestinale, Paralysie de l'intestin, Ileus paralysé, Iléus paralytique, ILEUS PARALYTIQUE |
German | Laehmung des Darms, adynamischer Ileus, Laehmung des Ileums, paralytischer Ileus, Paralytischer Ileus, ILEUS PARALYTISCH, Ileus paralytisch |
Italian | Paralisi dell'intestino, Ileo adinamico, Paralisi intestinale, Ileo paralitico |
Portuguese | Paralisia do íleo, Paralisia intestinal, Paralisia do intestino, Íleo paralítico, Íleo adinâmico, Íleo Paralítico, ILEUS PARALITICO, Íleus paralítico |
Spanish | Parálisis intestinal, Parálisis de intestino, Parálisis del íleon, Parálísis de íleon, Íleo adinámico, Íleo Paralítico, ILEO PARALITICO, parálisis del intestino, íleo adinámico, íleo paralítico (trastorno), íleo paralítico, Íleo paralítico |
Japanese | 麻痺性イレウス, 腸管麻痺, 腸麻痺, 回腸麻痺, チョウマヒ, カイチョウマヒ, チョウカンマヒ, マヒセイイレウス |
Czech | Adynamický ileus, Paralýza ilea, Paralýza střeva, Paralytický ileus, Intestinální paralýza, paralytický ileus |
Korean | 마비성 장폐색증 |
Hungarian | Adynamiás ileus, Intestinalis paralysis, Bél paralysise, Ileum parlaysis, Paralytikus ileus, Ileum paralysis, Hűdéses bélcsavarodás |
Norwegian | Paralytisk ileus, Lammelse i tarmen, Tarmlammelse |