What is Paralytic Ileus & How is it Treated?|Causes, Symptoms, Complications of Paralytic Ileus

The process by which the digested food is moved forward in an intestine is called as peristalsis. It is a wave like motion which causes muscle contraction and relaxation in the intestine. Ileus is a medical term used to describe a condition characterised by lack of these movements in the intestine, leading to food build up in the digestive tract along with obstruction. Paralytic ileus is a condition where there is lack of peristalsis in the intestine without actual mechanical obstruction. In most of the cases, paralytic ileus is a side effect of an abdominal surgery, but there are other causes of this condition besides surgery.

Paralytic ileus is a serious medical concern, and can lead to intestinal obstruction which may restrict the movement of solid, liquid and gas through the intestine. If the patient is unaware of this condition and continues to eat, it can lead to more build up in the intestine. This may cause perforation or tearing of the intestine, leading to leakage of the bowel content into the body cavity which contains high levels of bacteria and thus may have a deadly effect on the human body. Thus, it is very important to get Paralytic ileus treated as soon as possible to avoid any complications.

The most common symptom of paralytic ileus is extreme abdominal discomfort and distension with minimal pain. The pain may intensify with increasing distension. Other symptoms associated with Paralytic ileus include:

• Abdominal cramping
• Minimal or absence of bowel sounds
• Loss of appetite
• Bloating, swelling of the stomach and feeling of fullness
• Difficulty with passing gas
• Constipation
• Vomiting out of stool like contents
• Nausea
• Foul smelling breath
• Generalized weakness and feeling of discomfort.

The symptom usually last for 2 to 3 days. Most of these gastrointestinal symptoms are caused due to gas build up in the stomach and inability to release the gas through the rectum. As a result of which, the abdomen feels tight and swollen. It is very important to seek medical attention if these symptoms are felt after a surgery.

The most common cause of paralytic ileus is side effect of medication prescribed after an abdominal surgery, as these medications may slow down the normal intestinal movement. The intestine is not blocked, but may feel blocked due to little or no movement in the intestine. The most common medicines that are capable of causing paralytic ileus include:

• Dilaudid/Hydromophone
• Oxycodone
• Morphine
• Tricyclic anti-depressants (e.g. amitriptyline, imipramine etc.)
• Other miscellaneous drugs such as calcium channel blockers, loperamide, vincristine etc.

Other possible causes of paralytic ileus could be the following:

• Peritonitis
• Ischemia
• Retroperitoneal haemorrhage
• Spinal fracture
• Surgical manipulation of the bowel
• Systemic sepsis
• Uremia
• Shock
• Hypokalemia
• Myxedema
• Diabetic ketoacidosis.

It has been noted that paralytic ileus is the second most common reason for hospital readmission within 30 days after a surgery, especially abdominal surgery. Besides, these are factors which increases the risk of developing paralytic ileus includes:

• Electrolyte imbalance (potassium and calcium imbalance)
• History of intestinal issues such as diverticulitis, Crohn’s disease, intestinal injury, intestinal trauma etc.
• History of radiation over the abdominal area
• Sudden weight loss
• Sepsis
• Aging.

Diagnosis and management of paralytic ileus is done by an experienced gastroenterologist. Diagnosis involves obtaining a detailed case history followed by physical examination of the patient. Detailed history is obtained about recent history of surgeries and medications. Physical examination involves palpation and auscultation of the abdomen. It involves looking for symptoms such as swelling or tightness over the abdomen. It also involves listening for bowel sounds with a stethoscope, which is often absent in case of positive cases of paralytic ileus. Imaging studies are ordered to locate the exact area of gas build up, intestinal enlargement, or obstruction. The imaging studies that are ordered for includes:

• Radiographic Studies for Paralytic Ileus: Plain X-rays may show evidence of gas entrapment causing obstruction. However, x-rays may not be reliable in all cases.
• CT Scan to Diagnose Paralytic Ileus: These studies are more reliable than x-rays and may involve obtaining a scan using contrast agents taken orally or injected intravenously.
• Ultrasonography: This diagnostic method is commonly used in children. In some cases, it can be used for adults.
• Barium Enema to Diagnose Paralytic Ileus: This procedure involves taking an x-ray after inserting air or barium sulfate into the colon through the rectum.

The first step in treatment of paralytic ileus involves identification of the cause of the condition. If the causative medicine is correctly identified, the physician may alter the medication (discontinue or change the dosage) or prescribe another medication to stimulate intestinal movement. In advanced cases, a hospital stay may be necessary to ensure uptake of proper fluids by the body. Nasogastric tube suctioning may be needed. Nasogastric decompression is a procedure which involves insertion of tubes into the stomach through the nasal cavity, to suction out the extra air and material from the stomach. If the condition does not improve within 2 to 4 days after the surgery (which caused the condition) a second surgery may be required to correct the condition. In severe cases, a part or the entire intestine may be removed. A special pouch may be created (called as ostomy) to drain stool and other accumulation from the gastrointestinal tract.

If left untreated, paralytic ileus can lead to serious complications and even death. The most severe complications associated with this condition are discussed below:

• Necrosis: Necrosis is the death of tissue due to obstruction of blood supply to the intestinal tissue. This is mainly due to lack of oxygen. This leads to perforation on the intestinal wall followed by leakage of bowel material in the body cavity. This may cause excessive toxicity and uncontrolled bacterial infection leading to death.
• Peritonitis: Bowel perforation can cause inflammation of the abdominal cavity due to bacterial and fungal infection. This can cause sepsis, shock and organ failure leading to death.

Paralytic ileus is a relatively rare condition but should be treated immediately. The most common cause being medicines post abdominal surgery, one must be careful in noting if there is any discomfort that they are experiencing after the surgery. There are multiple ways in treating the condition at its initial stages; if not treated early, one might also have to undergo surgery to remove the entire intestine. Delay in treatment can also lead to tissue death or organ failure; hence, it should be treated immediately once diagnosed.

References:

Also Read:

• Gurgling Intestines: What Causes Your Stomach to Growl?
• What is Human Intestinal Parasites Infection: Causes, Symptoms, Treatment, Prognosis, Prevention
• Small Intestine Cancer: Causes, Symptoms, Treatment, Prognosis, Survival Rate
• What is Gastrointestinal Stromal Tumors & How is it Treated?
• Home Remedies for Intestinal Worms in Kids
• What is Intestinal Pain: Types, Causes, Symptoms, Treatment, Diagnosis