Definition. Ileus is an occlusion or paralysis of the bowel preventing the forward passage of the intestinal contents, causing their accumulation proximal to the site of the blockage. The passage of intestinal contents can be blocked either partially (subileus, incomplete ileus) or totally (complete ileus).
The most common cause of an ileus is abdominal or pelvic surgery which activates a stress response that immobilizes the digestive tract.
Surgery is the most common cause of paralytic ileus. Surgeons expect and plan for it following abdominal operations. But other surgeries can also trigger it.
Treatment of an ileus requires time and supportive management. Bowel rest, intravenous (IV) fluid therapy, and, if warranted, nasogastric (NG) decompression are important steps. Historically these treatments were thought to lower complications and improve outcomes, but a recent review of the evidence shows otherwise.
If ileus persists, it can cut off blood supply to the intestines and cause tissue death. This can result in an intestinal tear or infection of the abdominal cavity that can be life threatening.
In most cases, time and TLC will resolve your ileus and lessen your symptoms, but in severe cases you need immediate medical attention. An ileus is a condition in which the small intestine doesn't work normally. Normally, the muscles of the small intestines squeeze to move air, fluid, and food through it.
The symptoms of ileus are abdominal bloating and pain caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and cramps. People may pass watery stool.
Postoperative ileus typically resolves within a few days, although continued ileus introduces complications associated with lack of enteral intake, electrolyte derangements, malnutrition, and poor patient satisfaction.
The doctor may do a number of tests. These tests may include X-rays, blood tests, and a CT scan. Testing can help the doctor be sure that nothing is blocking the intestines. Most people who have ileus need to be treated in the hospital.
Signals from nerves tell the muscles when to contract. With ileus, this movement slows down or stops completely. As a result, waste can't move through the bowels and out of the body. This can cause belly (abdominal) pain and other symptoms.
Alvimopan is indicated to help prevent postoperative ileus following bowel resection. It has a longer duration of action than methylnaltrexone.
The manifestations of ileus and its degree of severity generally depend on the site of blockage. The rule until recently was that a patient with suspected mechanical ileus should be taken to surgery within 12 hours; today, however, ileus—particularly of the small bowel—can often be successfully treated conservatively.
Following abdominal surgery, a period of "physiologic" ileus is expected to last for 0 to 24 hours in the small intestine, 24 to 48 hours in the stomach, and 48 to 72 hours in the colon.
Conservative management. One of the most important steps in tackling ileus is early mobilization. That means getting patients out of the bed to walk in order to exert a mechanical stimulation of intestines.
Remove stalks, stems, pips, seeds and skins from fruit and vegetables. Chop and cook vegetables well. Reduce tough, fibrous fruit and vegetables – chop these foods finely where possible (e.g. celery, mango). Avoid dried fruits, nuts and seeds.
Obstruction of the bowel may be due to: A mechanical cause, which means something is blocking the bowel. Ileus, a condition in which the bowel does not work correctly, but there is no structural problem causing it.
Patients with post-operative ileus, opioid-induced constipation, or a soft stool will benefit from a stimulant laxative, such as senna or picosulphate.
Ileus is a slowing of gastrointestinal motility that is not associated with mechanical obstruction. Most commonly presents 2 to 3 days following surgery. Prolonged postoperative ileus (lasting 4 days or longer post-surgery) contributes significantly to longer hospitalisation.
Ileus Treatment
Your doctor might suggest: No food or fluids by mouth for 24 to 72 hours. Your doctor may also stop or cut back on strong pain relievers (opioid analgesics) or other medications that may be causing your symptoms. IV fluids to help correct any electrolyte imbalance.
Without any fluids (either as sips, ice chips or intravenously) people with a complete bowel obstruction most often survive a week or two. Sometimes it's only a few days, sometimes as long as three weeks. With fluids, survival time may be extended by a few weeks or even a month or two.
In cases of ileus, vomiting is usually infrequent; pain is mild, and distention is moderate to severe. Typically, the pain in small-bowel obstruction is crampy, with paroxysms occurring at 4- to 5-min intervals for proximal obstruction and less frequently for more distal obstruction.