II. Pathophysiology

  1. Paralysis of intestinal motility

III. Causes

  1. Abdominal Trauma
  2. Abdominal surgery (i.e. laparatomy)
  3. Serum Electrolyte abnormality
    1. Hypokalemia
    2. Hyponatremia
    3. Hypomagnesemia
    4. Hypermagensemia
  4. Infectious, Inflammatory or irritation (bile, blood)
    1. Intrathoracic
      1. Pneumonia)
      2. Lower lobe Rib Fractures
      3. Myocardial Infarction
    2. Intrapelvic (e.g. Pelvic Inflammatory Disease)
    3. Intraabdominal
      1. Appendicitis
      2. Diverticulitis
      3. Nephrolithiasis
      4. Cholecystitis
      5. Pancreatitis
      6. Perforated Duodenal Ulcer
  5. Intestinal Ischemia
    1. Mesenteric embolism, ischemia or thrombosis
  6. Skeletal injury
    1. Rib Fracture
    2. Vertebral Fracture (e.g. lumbar compression Fracture)
  7. Medications
    1. Opioids
    2. Phenothiazines
    3. Diltiazem or Verapamil
    4. Clozapine
    5. Anticholinergic Medications

IV. Symptoms

  1. Abdominal Distention
  2. Nausea and Vomiting are variably present
  3. Generalized abdominal discomfort
    1. Colicky pain of Mechanical Ileus is usually absent
  4. Flatus and Diarrhea may still be passed

V. Signs

  1. Quiet bowel sounds
  2. Abdominal Distention

VI. Differential Diagnosis

  1. Mechanical Ileus
  2. Bowel Pseudoobstruction
  3. See Ileus for diagnostic approach

VII. Radiology: Plain Flat and Upright Abdominal XRay

  1. Contrast with Mechanical Ileus
  2. Less prominent air fluid levels
  3. Generalized involvement of entire GI Tract
  4. Air filled bowel loops tend not to be distended

VIII. Radiology: Refractory ileus course

  1. Indicated to evaluate for Mechanical Ileus
  2. Upper GI series and Small Bowel follow through
    1. May be diagnostic and therepeutic
    2. Use gastrograffin instead of barium
      1. Barium may further obstruct bowel lumen
      2. Gastrograffin may stimulate bowel motility
    3. Decompress Stomach with Nasogastric Tube
    4. Instill gastrograffin via Nasogastric Tube
  3. CT Abdomen

IX. Management

  1. Initial
    1. Limit or eliminate oral intake
    2. Intravascular Fluid Replacement
    3. Correct Electrolyte abnormalities (e.g. Hypokalemia)
    4. Consider Nasogastric Tube placement
  2. Refractory Management (anecdotal evidence only)
    1. Consider Reglan 0.1 mg/kg/dose
    2. Consider lower bowel stimulation (e.g. Fleets Enema)

X. Course

  1. Post-operative ileus resolves within 24-48 hours

XI. References

  1. Torrey in Marx (2002) Rosen's Emergency Med, p. 1283-7
  2. Townsend (2001) Sabiston Surgery, p. 883-8
  3. Turnage in Feldman (1998) Sleisenger GI, p. 1799-804

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Related Studies

Ontology: Paralytic Ileus (C0030446)

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