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PARALYTIC ILEUS

History

Patients with ileus typically have vague, mild abdominal pain and bloating. They may report nausea, vomiting, and poor appetite. Abdominal cramping is usually not present. Patients may or may not continue to pass flatus and stool.

Physical

The abdomen may be distended and tympanic, depending on the degree of abdominal and bowel distention, and may be tender. A distinguishing feature is absent or hypoactive bowel sounds, in contrast to the high-pitched sound of obstruction. The silent abdomen of ileus reveals no discernible peristalsis or succussion splash.

Causes

Most cases of ileus occur after intra-abdominal operations. Normal resumption of bowel activity after abdominal surgery follows a predictable pattern: the small bowel typically regains function within hours; the stomach regains activity in 1-2 days; and the colon regains activity in 3-5 days.[15]

Serial abdominal radiographs mapping the distribution of radiopaque markers have shown that the colonic gradient for resolution of postoperative ileus is proximal to distal. The return of propulsive activity to the right colon occurs earlier than to the transverse or left colon.[16]

Other causes of adynamic ileus are as follows:

* Sepsis

* Drugs (eg, anesthesia, opioids, psychotropics, anticholinergics, antacids, warfarin, amitriptyline, chlorpromazine)

* Endocrine disorders (eg, diabetes, adrenal insufficiency, hypothyroidism)

* Metabolic (eg, low potassium, magnesium, or sodium levels; anemia; hyposmolality)

* Cardiopulmonary failure (eg, myocardial infarction)

* Pneumonia

* Trauma (eg, fractured ribs, fractured spine)

* Biliary and renal colic

* Neurosurgical procedures, spinal cord and head injuries

* Intra-abdominal inflammation and peritonitis

* Retroperitoneal and mediastinal pathology (eg, hematomas, infections)

Laboratory Studies

Laboratory studies and blood work should focus on evaluations for infectious, electrolytic, and...