Brief overview
- Causes: Blood clots in intestinal vessels, abdominal surgery, impaired nerve function, metabolic disorders, certain medications, chronic bowel disease.
- Symptoms: Nausea, vomiting, distended abdomen, diffuse abdominal pain, no bowel sounds.
- Course of disease and prognosis: Depending on the cause, life-threatening without treatment
- Examination and diagnosis: Physical examination, listening to the abdomen, X-ray, ultrasound examination
- Treatment: Intestinal peristalsis-stimulating drugs, stomach tube, enema, rarely also surgery
- Prevention: no general measure, digestive stimulating measures when taking certain medications
What is paralytic ileus?
In paralytic ileus, the intestinal passage is at a standstill. In contrast to the mechanical form, paralysis of the intestinal muscles is the cause here. There are several causes of paralytic bowel obstruction. Blood clots, abdominal surgery, bowel disease, and metabolic or nerve dysfunction are among the causes.
The symptoms of paralytic ileus usually occur more insidiously than in other forms of intestinal obstruction. A typical indication of intestinal paralysis is provided by listening to the abdomen: any bowel sounds are absent.
What are the causes of paralytic ileus?
There are various causes of paralytic ileus (intestinal paralysis). Sometimes it is caused by the occlusion of an intestinal vessel by a blood clot. The clot has then either formed directly on site in the blood vessel concerned (thrombus) or has been washed in with the bloodstream from elsewhere (embolus).
If the clot completely blocks the vessel, the intestinal tissue that is actually supplied by this vessel no longer receives oxygen and nutrients – it dies (necrosis). Physicians refer to this event as a mesenteric infarction.
In other cases, paralytic ileus develops as a reflex after operations in the abdominal cavity. The operation triggers mechanical stimuli, causing the movement of the intestine to stop (postoperative ileus). Paralytic ileus also sometimes occurs reflexively during biliary or renal colic.
In diseases affecting the nerves (such as syringomyelia, herpes zoster), so-called neurogenic intestinal paralysis sometimes occurs.
Chronic inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis are also the cause of paralytic ileus in some cases.
Furthermore, certain drugs sometimes cause intestinal paralysis. These include, for example, strong painkillers from the opiate group, Parkinson’s drugs, antidepressants, and antispasmodic drugs (spasmolytics). In extreme cases, the abuse of laxatives can also lead to paralytic ileus.
Disturbances of the electrolyte balance and metabolism are also possible causes. For example, potassium deficiency (hypokalemia) and ketoacidotic coma (a severe complication of diabetes mellitus) put patients at risk for intestinal arrest.
In some patients, paralytic ileus can be attributed to urinary toxicity. This is understood to be an accumulation of urinary substances in the blood (uremia) as a result of impaired kidney function. Other possible causes of paralytic ileus include hypothyroidism (underactive thyroid gland) and abdominal injuries.
Note: Sometimes paralytic ileus develops from mechanical ileus (i.e., bowel obstruction due to a mechanical obstruction).
What are the symptoms of paralytic ileus?
In intestinal paralysis, the abdomen is initially very distended. As the condition progresses, the abdominal wall is very tense and hard (drum belly). Neither stool nor wind passes (stool and wind retention).
Hiccups, nausea, vomiting, and pain in the abdominal area are other common symptoms.
What is the prognosis for paralytic bowel disease?
The course of disease in paralytic bowel obstruction depends on its cause. If left untreated, there is a risk of life-threatening complications developing. This is especially true if the bowel paralysis has followed a mechanical bowel obstruction.
In cases of reflex intestinal paralysis following surgery, the prognosis is usually good with appropriate treatment.
How is paralytic ileus diagnosed?
Physical examination and x-ray are the most important steps in diagnosing paralytic ileus:
During the physical examination, the physician listens to the abdomen thoroughly with a stethoscope. If bowel sounds are not heard in any abdominal region, paralytic ileus is strongly suspected. Doctors refer to the phenomenon as “sepulchral silence” in the abdomen. If bowel sounds are audible, this rules out paralytic ileus.
How is paralytic ileus treated?
Patients with paralytic ileus (or another form of intestinal obstruction) are initially not allowed to eat or drink anything until the intestines have recovered through therapy. Patients receive necessary fluids and nutrients through an IV.
In addition, drugs can be administered via the vein access. These are primarily active ingredients that stimulate the movement of the intestines (peristalsis). They are used to get the paralyzed bowel moving again. If necessary, patients are given other medications such as painkillers or anti-nausea and anti-vomiting agents.
In addition, a stomach tube is inserted to drain stagnated stomach and intestinal contents. The bowel can also be emptied with the help of a rectal enema.
In addition, it is important to eliminate the cause of the intestinal paralysis. For example, hypothyroidism or a severe metabolic derailment in diabetics as triggers of paralytic ileus must be treated accordingly.
Such conservative measures are usually sufficient to correct intestinal paralysis. Surgery is necessary, however, if paralytic ileus has developed from a mechanical bowel obstruction or if peritonitis is present.
Can paralytic ileus be prevented?
People who take certain medications (such as opiates) may be at higher risk for paralytic ileus. In that case, it makes sense to seek advice from a doctor on what measures – such as in the diet – contribute to healthy bowel motor function.
It is not advisable to take laxatives on your own. This is because some of these agents cause the body to become habituated when used continuously. As a result, there is a risk that intestinal paralysis may occur. If you suffer from constipation, it is advisable to talk to your doctor about sensible countermeasures.
