Intestinal Obstruction (Paralytic Ileus)
What is Intestinal Obstruction?
Intestinal obstruction can occur due to surgery or illness. As a result, contents in the intestine can no longer be transported and accumulate. This manifests as abdominal pain, a bloated stomach, and nausea. The goal of treatment is to restore intestinal function.
At a Glance
- Paralytic ileus is a type of intestinal obstruction.
- Due to the paralysis of the intestinal muscles, nutrients can no longer be transported and accumulate in the intestine.
- There are many possible causes of paralytic ileus, such as abdominal or intestinal surgery or inflammation.
- Typical symptoms of intestinal obstruction are abdominal pain, a bloated stomach, nausea, vomiting, and constipation.
- Treatment mainly consists of measures to empty the intestine and stimulate intestinal movements.
- Note: The information in this article cannot replace a doctor’s examination and should not be used for self-diagnosis or treatment.
What is Paralytic Ileus?
Paralytic ileus is the paralysis of the intestinal muscles. Nutrients in the intestine can no longer be transported and accumulate. It is impossible to empty the intestine.
Normally, intestinal movements ensure the transport and elimination of nutrients in the intestine. However, in the case of paralytic ileus, these movements are so weakened or uncoordinated that these processes no longer occur.
Chyme, gases, and fluids accumulate in the intestine, causing the intestinal wall to stretch increasingly. This can lead to a significant expansion of the intestine. If not treated in time, there is a risk of damage to the intestinal wall or even the death of sections of the intestine.
What are the Symptoms of Paralytic Ileus?
Symptoms of intestinal obstruction usually develop gradually over several days. Initially, there is mild abdominal pain. The abdomen becomes increasingly bloated. It is typical for the abdominal pain to persist.
Other symptoms of paralytic ileus include:
- Nausea
- Vomiting
- Constipation
- Inability to pass gas: Air and gases cannot exit the intestine.
What Causes Paralytic Ileus?
Paralytic ileus is caused by a disruption in the function of the nerves or muscles in the intestinal wall. This is usually due to another disease or disorder. The exact mechanism of how intestinal obstruction develops is not fully understood.
Possible triggers include:
- Surgery (especially in the abdominal area)
- Severe injuries (e.g., in the pelvis or spine)
- Cancer diseases
- Nervous system diseases (e.g., Parkinson’s disease, Alzheimer’s dementia, or multiple sclerosis)
- Metabolic disorders due to liver or kidney disease, diabetes, or excessive alcohol consumption
- Deficiency of minerals such as potassium, calcium, or magnesium
- Disorders in intestinal circulation
- Medications such as strong painkillers (opioids), depression drugs, or anesthetics
Interesting Fact: It is normal for intestinal movements to slow down to some extent after surgery. The stress of surgery or direct impact on the intestine during abdominal surgery can hinder intestinal movements.
Which Factors Lead to Paralytic Ileus?
After certain surgeries in the abdomen, pelvis, or gastrointestinal system, the slowdown in intestinal movements may last longer than usual and lead to intestinal obstruction.
Other factors that increase the risk of paralytic ileus include:
- Prolonged surgeries
- Postoperative complications
- Use of certain painkillers during surgery
- Delayed feeding or artificial feeding via a nasogastric tube
- Inflammation in the abdominal area
How Common is Paralytic Ileus?
Paralytic ileus is quite common. After abdominal surgery, 10% to 30% of people experience paralysis in the intestinal muscles.
How Does Paralytic Ileus Progress?
The small intestine usually becomes active again a few hours after surgery. The colon will start functioning normally again after 2 to 3 days.
If paralytic ileus lasts more than 3 to 5 days, it is called prolonged ileus. This then causes discomfort. Supportive treatment helps to stimulate intestinal movements again.
Can Complications Occur?
If the intestine becomes very stretched due to accumulated nutrients and gases or if the obstruction lasts longer than 6 days, complications can arise.
Possible consequences include peritonitis, localized rupture of the intestine, impaired blood flow in the intestine, or the death of sections of the intestine.
How Can Paralytic Ileus be Prevented?
Various measures can be taken to prevent intestinal obstruction after surgery: Early exercise and food intake post-surgery stimulate intestinal activity. Chewing gum can also have a preventive effect.
How is Paralytic Ileus Diagnosed?
The doctor will ask about the symptoms and perform a physical examination. Abdominal bloating, constipation, and the absence of bowel sounds indicate paralytic ileus.
The doctor also takes an abdominal X-ray. Enlarged intestinal loops can be clearly seen on the X-ray.
Computed tomography (CT) and magnetic resonance imaging (MRI) can also be used to rule out a mechanical obstruction as a trigger for intestinal obstruction.
Blood is also examined to find possible causes. The doctor can determine if there are signs of impaired blood flow or inflammation using blood values.
How is Paralytic Ileus Treated?
If the cause of paralytic ileus is a disease, doctors first treat the disease if possible.
In the first 1-2 days after the onset of intestinal obstruction, the main task is to empty the intestine. This is usually achieved through the following measures:
- The person should not eat or drink anything initially.
- Necessary fluids are supplied via infusion.
- Trapped nutrients in the stomach and small intestine can be drained through a nasogastric tube.
- An enema in the rectum helps to empty the intestine.
- Walking around and changing body positions can help stimulate the intestine.
If these measures are not sufficient, additional medications may be used to stimulate intestinal movements. The active ingredient neostigmine is commonly used but has limited effectiveness. Side effects such as low blood pressure and tremors may occur.
If medication is not helpful or cannot be used due to side effects, the doctor may try to aspirate the intestinal contents using a special tube during a colonoscopy.
Surgery is rarely necessary. However, surgery may be required if there is a risk of intestinal rupture.
