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Adynamic Ileus
Aka: Adynamic Ileus, Paralytic Ileus, Adynamic Bowel Obstruction, Functional Bowel Obstruction, Neurogenic Bowel Obstruction
- Pathophysiology
- Paralysis of intestinal motility
- Causes
- Abdominal Trauma
- Abdominal surgery (i.e. laparatomy)
- 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
- Appendicitis
- Diverticulitis
- Nephrolithiasis
- Cholecystitis
- Pancreatitis
- Perforated Duodenal Ulcer
- Intestinal Ischemia
- Mesenteric embolism, ischemia or thrombosis
- Skeletal injury
- Rib Fracture
- Vertebral Fracture (e.g. lumbar compression Fracture)
- Medications
- Opioids
- Phenothiazines
- Diltiazem or Verapamil
- Clozapine
- Anticholinergic Medications
- Symptoms
- Abdominal Distention
- Nausea and Vomiting are variably present
- Generalized abdominal discomfort
- Colicky pain of Mechanical Ileus is usually absent
- Flatus and Diarrhea may still be passed
- Signs
- Quiet bowel sounds
- Abdominal Distention
- Differential Diagnosis
- Mechanical Ileus
- Bowel Pseudoobstruction
- See Ileus for diagnostic approach
- 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
- 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
- Management
- Initial
- Limit or eliminate oral intake
- Intravascular Fluid Replacement
- Correct Electrolyte abnormalities (e.g. Hypokalemia)
- Consider Nasogastric Tube placement
- Refractory Management (anecdotal evidence only)
- Consider Reglan 0.1 mg/kg/dose
- Consider lower bowel stimulation (e.g. Fleets Enema)
- Course
- Post-operative ileus resolves within 24-48 hours
- References
- 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