Paralytic bowel obstruction causes the movement of the bowel (peristalsis) to stop suddenly. The intestinal contents can no longer be transported toward the rectum because of the intestinal paralysis. As in mechanical intestinal obstruction, the germs contained in the intestinal contents can pass through the intestinal wall. They enter the abdominal cavity and lead to peritonitis. This results in what is known as acute abdomen (acute abdomen).
Paralytic intestinal obstruction secondary to peritonitis.
Conversely, existing peritonitis can also lead to paralytic bowel obstruction. Rapid onset (acute) and prolonged (chronic) inflammatory processes of the abdominal organs can extend to the abdominal cavity as a result of wall damage to the affected organ, again causing a severe inflammatory reaction of the abdominal cavity or peritoneum (peritonitis).
Regardless of the cause of peritonitis, a crippling intestinal obstruction (paralytic ileus) develops as a result of peritonitis. The intestinal loops are no longer able to move intestinal contents.
What causes paralytic ileus?
In this form of bowel obstruction, the intestinal lumen is not constricted. The passage of stool is obstructed by metabolic, toxin-induced, or reflex intestinal paralysis (= paralysis).
Particularly inflammatory gastrointestinal diseases lead thereby via peritonitis to a paralyzing intestinal obstruction:
- A perforated gastric or small bowel ulcer (perforated ventriculi ulcer or duodenal ulcer).
- Gallbladder inflammation (acute cholecystitis).
- Pancreatitis (acute pancreatitis).
- Perforated inflammation of an intestinal diverticulum (perforated diverticulitis).
- Dangerous complication of ulcerative colitis (toxic megacolon).
- Contagious gastroenteritis (acute infectious gastroenteritis).
- Appendicitis (acute appendicitis).
Paralytic ileus: Other causes
Apart from inflammatory diseases, obstruction of one of the major abdominal arteries may also be responsible for paralytic ileus. Two major arteries branch off from the aorta (main artery) in the abdomen, supplying blood to almost the entire small and large intestines. These are the superior and inferior mesenteric arteries. Like all arteries in the human body, these are subject to an arteriosclerotic process with age. Occlusion of one of these vessels leads to a condition known as mesenteric infarction.
The intestinal tissue dependent on the mesenteric arteries can no longer be adequately supplied with blood and oxygen. This serious circulatory disturbance leads to the death of the intestine. The intestinal walls become permeable, and the contents of the intestinal loops can migrate unhindered into the abdominal cavity. The peritoneum becomes inflamed, and a crippling intestinal obstruction (paralytic ileus) develops.
Most often, older people are affected. Changes in blood salts can also lead to paralytic bowel obstruction. Blood salts (electrolytes) are responsible for causing the muscles, including the intestinal muscles, to contract and thus perform the desired movement. Especially changes in potassium levels lead to such changes. Furthermore, as a consequence of a vertebral fracture, the intestine may react with (temporary) paralysis. Therefore, patients with vertebral fractures must also eat a light diet for a few days to minimize the risk of intestinal paralysis.
