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Ileus: Difference between revisions
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(Created page with "Ileus refers to the inability of intestinal contents to pass through the intestinal tract. We can distinguish multiple types according to the pathomechanism: * Mechanical ileus – due to a mechanical obstruction of the bowels ** Obstructive ileus ** Bowel strangulation * Dynamic ileus – due to functional impairment of peristalsis ** Paralytic ileus ** Spastic ileus Obstructive ileus may be further classified as small bowel obstruction (SBO), large bowel obstruction,...") |
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Ileus refers to the inability of intestinal contents to pass through the intestinal tract. We can distinguish multiple types according to the pathomechanism: | '''Ileus''' refers to the inability of intestinal contents to pass through the intestinal tract. We can distinguish multiple types according to the pathomechanism: | ||
* Mechanical ileus – due to a mechanical obstruction of the bowels | * '''Mechanical ileus''' – due to a mechanical obstruction of the bowels | ||
** Obstructive ileus | ** Obstructive ileus | ||
** Bowel strangulation | ** Bowel strangulation | ||
* Dynamic ileus – due to functional impairment of peristalsis | * Dynamic ileus – due to functional impairment of peristalsis | ||
** Paralytic ileus | ** '''Paralytic ileus''' | ||
** Spastic ileus | ** Spastic ileus | ||
Obstructive ileus may be further classified as small bowel obstruction (SBO), large bowel obstruction, and gastric outlet obstruction. Mechanical ileus is an emergency as it may lead to strangulation, bowel perforation, and sepsis. | Obstructive ileus may be further classified as small bowel obstruction (SBO), large bowel obstruction, and gastric outlet obstruction. Mechanical ileus is an emergency as it may lead to [[Bowel strangulation|strangulation]], [[Gastrointestinal perforation|bowel perforation]], and [[sepsis]]. | ||
Because spastic ileus is so rare, most authors divide ileus into mechanical and paralytic types, ignoring spastic ileus completely. | Because spastic ileus is so rare, most authors divide ileus into mechanical and paralytic types, ignoring spastic ileus completely. | ||
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* Luminal obstruction from the inside | * Luminal obstruction from the inside | ||
** Faecal impaction | ** Faecal impaction | ||
** Gallstone | ** [[Gallstone ileus|Gallstone]] | ||
** Foreign body | ** Foreign body | ||
** Parasites | ** Parasites | ||
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** Polyp | ** Polyp | ||
* Compression from the outside | * Compression from the outside | ||
** Bowel strangulation (strangulated hernia, volvulus, intussusception) | ** [[Bowel strangulation]] (strangulated hernia, volvulus, intussusception) | ||
** Adhesions | ** Adhesions | ||
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Bowel strangulation refers to the condition when the bowel is “strangulated”, which cuts of the blood supply of the affected bowel segment. This can occur due to bowel incarceration, volvulus, or intussusception. Volvulus refers to when a loop of bowel twists around the mesentery that supports it. Intussusception occurs when a segment of bowel folds into itself like a telescope. See the image [https://www.msdmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/intestinal-obstruction here]. | Bowel strangulation refers to the condition when the bowel is “strangulated”, which cuts of the blood supply of the affected bowel segment. This can occur due to bowel incarceration, volvulus, or intussusception. Volvulus refers to when a loop of bowel twists around the mesentery that supports it. Intussusception occurs when a segment of bowel folds into itself like a telescope. See the image [https://www.msdmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/intestinal-obstruction here]. | ||
== | == Other types of ileus == | ||
Paralytic ileus refers to ileus due to paralysis of the bowel wall muscles which drive peristalsis. This can occur due to a variety of reasons, most commonly due to: | Paralytic ileus refers to ileus due to paralysis of the bowel wall muscles which drive peristalsis. This can occur due to a variety of reasons, most commonly due to: | ||
* Abdominal surgery (postoperative ileus) | * Abdominal surgery (postoperative ileus) | ||
* Hypokalaemia and other electrolyte disturbances | * [[Hypokalaemia]] and other electrolyte disturbances | ||
* Diabetes mellitus | * [[Diabetes mellitus]] | ||
* Peritonitis | * [[Peritonitis]] | ||
* Anticholinergic or opioid drugs | * [[Anticholinergic drug|Anticholinergic]] or [[opioid]] drugs | ||
Postoperative (paralytic) ileus is common and physiologic. It typically resolves spontaneously within 72 hours. | Postoperative (paralytic) ileus is common and physiologic. It typically resolves spontaneously within 72 hours. | ||
Spastic ileus refers to ileus due to spasm of bowel wall muscles. This is very rare, but may occur due to porphyria, uraemia, or heavy metal poisoning. | Spastic ileus refers to ileus due to spasm of bowel wall muscles. This is very rare, but may occur due to [[porphyria]], [[uraemia]], or [[heavy metal poisoning]]. | ||
== Clinical features == | == Clinical features == | ||
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== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Patients should be evaluated for herniation and trauma. Digital rectal examination should be performed, as the rectum will be tight (collapsed) in case of mechanical ileus and loose in case of paralytic ileus. Blood per DRE may be a sign of strangulation or cancer. | Patients should be evaluated for herniation and trauma. [[Digital rectal examination]] should be performed, as the rectum will be tight (collapsed) in case of mechanical ileus and loose in case of paralytic ileus. Blood per DRE may be a sign of strangulation or cancer. | ||
Abdominal x-ray or CT should be performed and may show characteristic air-fluid levels in the bowels, bowel dilation proximal to the obstruction, and sometimes the point of mechanical obstruction itself. | Abdominal [[x-ray]] or [[CT]] should be performed and may show characteristic air-fluid levels in the bowels, bowel dilation proximal to the obstruction, and sometimes the point of mechanical obstruction itself. | ||
== Treatment == | == Treatment == | ||
Ileus is an emergency and should always be treated inpatient. The initial intervention is stabilisation. IV fluids are often necessary due to hypovolaemia, and any electrolyte disturbances should be treated. A nasogastric tube should always be placed to decompress the bowels. Prophylactic antibiotics should be used for complicated ileus. | Ileus is an emergency and should always be treated inpatient. The initial intervention is stabilisation. IV fluids are often necessary due to [[hypovolaemia]], and any electrolyte disturbances should be treated. A nasogastric tube should always be placed to decompress the bowels. Prophylactic antibiotics should be used for complicated ileus. | ||
Mechanical ileus requires surgery or endoscopy to treat the underlying cause. Complicated mechanical ileus requires emergency surgery, while uncomplicated ileus may only require timely surgery. | Mechanical ileus requires surgery or endoscopy to treat the underlying cause. Complicated mechanical ileus requires emergency surgery, while uncomplicated ileus may only require timely surgery. | ||
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* Bowel necrosis | * Bowel necrosis | ||
* Bowel perforation | * [[Gastrointestinal perforation|Bowel perforation]] | ||
* Peritonitis | * [[Peritonitis]] | ||
* Hypovolaemic shock | * [[Hypovolaemic shock]] | ||
* Sepsis | * [[Sepsis]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||