67. Mechanical Ileus. Ileus per obturationem

Question 1

Mechanical Ileus - Definition

Answer 1

Aka paralytic ileus

Decreased temporarily arrest of intestinal peristalsis

Disturbance of peristalsis of the gastrointestinal tract in the absence of mechanical obstruction

Question 2

Mechanical Ileus - Etiology

Answer 2

• Intra-abdominal surgery or trauma (e.g., laparotomy, retroperitoneal haemorrhage)
• Endocrine (e.g., diabetes mellitus, hypothyroidism, porphyria, uraemia)
• Electrolyte disturbances (e.g., hypokalaemia)
• Neurosurgical procedures (e.g., spinal surgery)
• Vascular (e.g., mesenteric infarct)
• Inflammation of intra-abdominal organs (e.g., appendicitis, cholecystitis) and peritonitis
• Medication (e.g., anticholinergics, opioids, antidepressants)

Question 3

Mechanical Ileus - Pathophysiology:

Answer 3

• Activation of α and β-receptors due to intestinal stress

→

Arrested peristalsis

→

bowel wall distention

→

progresses as detailed above in mechanical bowel obstruction

Question 4

Mechanical Ileus - Clinical presentation

Answer 4

• Similar to mechanical obstruction
• Ab distention – steady pain (not colicky like in mechanical obstruction)
• N/V
• Pt may pass diarrhoea
• Absence of bowel sounds

Question 5

Mechanical Ileus - Diagnostic Investigations

Answer 5

• X-ray = Gas throughout intestine inc. colon

- X-ray with contrast = barium – helps distinguish ileum from mechanical obstruction

Question 6

Mechanical Ileus - Treatment

Answer 6

NBM

NGT

IV fluids

Cease drugs causing ileus

Correct metabolic + electrolyte abnormalities – NaCl stimulates peristalsis

Electro stimulation with probes on ant ab wall

Enema as last line

Laporatomy to exclude hidden causes + allows more bowel decompression to be done