Paralytic Ileus

From: Helen Dynda (
Thu Aug 2 12:42:50 2001

July 05, 1998

[] What is paralytic ileus? Paralytic ileus (also called adynamic ileus) is one type of intestinal obstruction.

Recall that the movement of food through the intestines can be impeded in two rather different ways:

1.) either by a physical obstruction of the lumen such as a growing tumor, a mass of parasitic worms, hernia, intussusception, or a foreign object -- anything that impedes the progress of food along the digestive tract 2.) or by a loss of normal peristaltic function in a part or all of the intestine, as for example when the smooth muscle in the intestinal wall fails to work because of a severe electrolyte imbalance, a loss of nerve or blood supply, or the presence of a toxin or an anticholinergic drug.

The incidence of paralytic ileus is high in comparison to physical obstruction but generally the prognosis is better. Paralytic ileus is frequently encountered when nursing patients on surgical wards following an operation. It is also a major cause of obstruction in infants and children, where it is sometimes referred to as pseudo-obstruction (Barr, 1998). Peristalsis ceases and stagnation occurs in both the small and large bowel producing severe nausea and vomiting. There is abdominal distention and a reduction or absence of bowel sounds.

The many situations which can provoke paralytic ileus include:

** peritonitis

** trauma to the nerves supplying the gut wall during intra-abdominal surgery

** decreased blood supply to the intestinal wall ** prolonged use of opiates either during an operation or in the post operative phase

** metabolic disturbances, particularly those which result in decreased potassium levels

** spinal injury

** pneumonia

** pancreatitis

The condition is managed by inserting a naso-gastric tube and aspirating the stomach contents. The objective is to decompress and rest the intestine as this will relieve abdominal distention and vomiting. Thereafter aspiration takes place at regular intervals (hourly) or the naso-gastric tube is placed on siphon drainage until the condition resolves. Electrolyte and fluid balance are restored and maintained by giving crystalloid solutions intravenously with potassium being added as required. If the patient does not improve rapidly with these conservative measures, an operation will be required to locate the obstruction and restore normal bowel continuity and function.

click here for clinical notes about acute intestinal obstruction

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