Small Intestine: Ileus

Ileus (Adynamic/Paralytic Ileus)

Definition

  • Generalized Dysfunction of Peristalsis Involving the Entire GI Tract

Risk Factors

  • Surgery (Postoperative Ileus) – Most Common Cause
    • Higher Risk After Open Surgery than Laparoscopic
  • Low Potassium
  • Trauma
  • Severe Burns
  • Inflammation
  • SIRS/Sepsis
  • Pneumonia
  • Pancreatitis
  • Medications: Opiates, Antihistamines, Anticholinergics & Alpha-Agonists

Symptoms

  • Nausea & Vomiting
  • Diffuse Persistent Pain
  • Abdominal Distention
  • Obstipation (Unable to Pass of Flatus or Stool)

Diagnosis

  • Radiology: Uniform Dilation without Decompression

Treatment

  • Tx: Supportive Cares
    • Nonnarcotic Pain Control
    • IV Fluids & Electrolyte Replacement
    • Bowel Rest
    • NG Tube Decompression for Continuous Emesis or Significant Distention
    • Repeat Abdominal Imaging After 48-72 Hours if No Improvement Seen

Prevention

  • Proven Preventions:
    • Minimally Invasive Surgery
    • Epidural or TAP (Transverse Abdominis Plane) Blocks
    • Alvimopan (Entereg) – Peripheral Opioid Receptor Antagonist
    • Multimodal Analgesia with Reduced Opioid Use
    • Correction of Electrolyte Abnormalities
  • Questioned Preventions – Probably Have a Benefit but Debated:
    • Chewing Gum
    • Coffee
  • Ineffective Preventions:
    • Early Ambulation – Has Other Benefits
    • Routine Delayed Enteral Feeding
    • Prophylactic NG Tube Decompression
    • Methylnaltrexone (Relistor) – Peripheral Opioid Receptor Antagonist

Adynamic Ileus on Plain Film 1

References

  1. Chua C, Gurnurkar S, Rodriguez-Prado Y, Niklas V. Prolonged ileus in an infant presenting with primary congenital hypothyroidism. Case Rep Pediatr. 2015;2015:584735. (License: CC BY-3.0)