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ileus

Intestinal paralysis. Etiology: 1) abdominal surgery 2) abdominal or spinal trauma 3) abdominal infection/inflammation a) peritonitis b) pancreatitis c) appendicitis d) acute cholecystitis 4) pharmacologic agents: a) aluminum hydroxide b) barium sulfate c) calcium carbonate d) ferrous sulfate e) ion exchange resins f) opiates g) phenothiazines h) tricyclic antidepressants i) verapamil Pathology: - lack of intestinal peristalsis Clinical manifestations: 1) pain is generally constant & mild 2) abdominal distension Laboratory: 1) blood work generally of no value 2) plain abdominal radiograph (KUB) supine & upright - gas in both small & large bowel. Differential diagnosis: 1) constipation 2) intestinal pseudoobstruction 3) intestinal obstruction Management: - postoperative ileus - minimization of opioid use* [2] - adequate hydration - bowel rest - electrolyte repletion - ambulation [2] - alvimopan may be useful [4] - chewing gum may be useful [2,3] * opioids unlikely to be only cause of ileus, thus methylnaltrexone not indicated [5]

Related

intestinal pseudo-obstruction

Specific

meconium ileus

General

hypoperistalsis

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39.
  2. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  3. The NNT: Chewing Gum for Reducing Post-Caesarian Section Ileus. http://www.thennt.com/nnt/chewing-gum-for-reducing-post-caesarian-section-ileus/ - Craciunas L, Sajid MS, Ahmed AS. Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta- analysis of randomised controlled trials. BJOG. 2014 Jun;121(7):793-9; discussion 799 PMID: 24628729
  4. Taguchi A, Sharma N, Saleem RM, Sessler DI, Carpenter RL, Seyedsadr M, Kurz A. Selective postoperative inhibition of gastrointestinal opioid receptors. N Engl J Med. 2001 Sep 27;345(13):935-40. PMID: 11575284 Free Article
  5. Vilz TO, Stoffels B, Strassburg C, et al. Ileus in adults. Dtsch Arztebl Int. 2017;114:508-18. PMID: 28818187