Ileus: Stopped bowel movements with obstruction of the intestines

An ileus is a condition where the bowel movements have stopped. The intestines cannot let the food through in the normal way, which often occurs after abdominal surgery but also with other conditions and environmental factors. This serious condition cuts off the blood supply to the intestines untreated, causing the intestinal tissue to die. This results in a serious intestinal trauma or a life-threatening infection of the abdominal cavity. It is essential to seek medical help quickly as soon as the symptoms appear. Adjustments in medication or nutrition and sometimes surgery are necessary to treat an ileus. Finally, the outlook is generally good.
  • Causes: Stopped bowel movements
  • Abdominal surgery
  • Infections and disorders
  • Risk factors of ileus
  • Symptoms
  • Ileus versus intestinal obstruction
  • Diagnosis and investigations
  • Treatment of obstruction of the intestines
  • Ileus after surgery
  • Nutritional adjustments
  • Medication
  • Surgery
  • Complications
  • Infection
  • Necrosis
  • Prognosis of bowel disease

Causes: Stopped bowel movements

The intestinal movements (peristalsis) ensure that food can travel through the intestines. In the case of an ileus, peristalsis is stopped and food particles, gas and liquids can no longer travel through the digestive tract. If the patient continues to eat, the food particles accumulate, which leads to a partial or complete obstruction of the intestines (intestinal obstruction).
Some medications may cause an ileus after abdominal surgery / Source: Stevepb, Pixabay

Abdominal surgery

An ileus usually develops after abdominal surgery or surgery to the pelvic area. This is because normal peristalsis slowly returns after surgery. It is also possible that medication prescribed by the doctor after the operation affects the bowel movement. Postoperative scars also sometimes cause a blockage.
Some medicines that affect muscles and nerves in the digestive tract include:
  • anticholinergics (drugs that treat many conditions such as bladder problems, COPD (chronic obstructive pulmonary disease) and Parkinson's disease (neurological disorder with tremors)
  • calcium channel blockers (medicines prescribed by the doctor for heart defects)
  • opioid analgesic medication

Infections and disorders

Other causes of an ileus are infections and disorders of the muscles and nerves, such as:
  • appendicitis (inflammation of the appendix of the appendix)
  • colon cancer
  • Crohn's disease
  • Parkinson's disease
  • diverticulitis
  • a stomach infection
  • a lung disease
  • a kidney disease
  • decreased blood flow to the intestines
  • electrolyte disorder (such as low levels of potassium in the blood)
  • gastroenteritis (stomach flu: infection with a bacterium or a virus)
  • intussusception: Here a part of the intestine is pushed into itself (just like closing a telescope); this is common in children

Risk factors of ileus

Some factors that increase the risk of an ileus are:
  • blood poisoning (sepsis)
  • an intestinal disorder such as irritable bowel syndrome, Crohn's disease or diverticulitis
  • a bowel injury
  • an electrolyte disorder
  • a history of radiotherapy near the abdomen
  • an older age
  • a peripheral vascular disease
  • lose weight very quickly

Symptoms

An ileus may cause an acute abdomen which is accompanied by the following possible signs:
  • abdominal cramps
  • stomach ache
  • vomit
  • constipation, or passing small amounts of aqueous stools
  • a bloated or swollen belly
  • bad breath (halitosis)
  • a loss of appetite
  • feeling full
  • the inability to ignore
  • stomach cramps
  • stomach ache
  • nausea

Ileus versus intestinal obstruction

An ileus and bowel obstruction are not completely the same, although both show similar symptoms. An ileus is in fact the result of muscle or nerve problems that have stopped peristalsis. With an intestinal obstruction (intestinal obstruction) there is a physical blockage in the digestive tract. However, a paralytic ileus may cause a physical blockage due to an accumulation of food in the intestines. This causes paralysis (paralysis) of the intestine.
Other causes for bowel obstruction include:
  • colon cancer
  • diverticulitis (inflamed diverticula = bulges in the digestive tract)
  • a hernia
  • faecal impaction (stuck dry and hard lump stools)
  • areas of fibrous tissue that form after surgery (intestinal adhesions)
  • inflammatory bowel disease

Diagnosis and investigations

Interview and physical examination
To diagnose an ileus, the doctor first asks the patient about the symptoms present and also goes through the complete medical history. The doctor also wants information about:
  • the surgical history
  • current or past medical conditions
  • the use of medication

The doctor then carries out a physical examination in which he looks for signs of swelling or pain in the abdomen. The doctor uses a stethoscope to listen to the intestinal sounds. This 'listening examination' is known in medical terms as 'auscultation'. Absent (paralytic ileus) or excessively active (mechanical ileus) intestinal sounds may indicate an ileus, but imaging tests are usually required to confirm a diagnosis.
Diagnostic research
Imaging investigations locate an ileus. The doctor uses an x-ray, ultrasound or CT scan of the abdomen. Sometimes an air barium enema is also needed. The doctor places air or liquid barium in the colon through the rectum and then takes x-rays of the abdomen.

Treatment of obstruction of the intestines

Treatment depends on the underlying cause of ileus. The treatment usually consists of:
  • a wait and see policy
  • nutritional adjustments
  • take or adjust medication
  • an operation

Ileus after surgery

If ileus occurs after surgery, the patient is recovered after a few days. Paralytic ileus usually disappears when a patient makes changes to the medication. Hospitalization is often required until the problems have been fully resolved. The patient then receives:
  • intravenous (through a vein) fluid administration to prevent dehydration
  • nasogastric decompression (a tube sucks off material that a patient could otherwise throw up)
  • painkillers

Nutritional adjustments

Disorders such as Crohn's disease (disorder with diarrhea and abdominal pain) and diverticulitis lead to partial bowel blocking. Some intestinal materials then pass through the intestine, but not everything. Consuming a low-fiber diet is recommended to make it easier for the patient to get stools. The patient is only allowed to eat whole grain food, raw vegetables and nuts to a limited extent.

Medication

A paralytic ileus that results from use of medication is often easy to remedy by taking another medication to stimulate the bowel movement. Sometimes the doctor advises to stop taking the medication that causes the ileus.

Surgery

In the event of a serious intestinal obstruction or when dietary guidelines and medicines do not work, surgery is required. The doctor removes the blockage or repairs or removes the damaged part of the intestine. The extended operation may not be suitable for the elderly or patients with colon cancer. They may receive a stent (tube) to keep the intestine open and allow the intestinal materials to pass through more easily. Sometimes the doctor has to remove an entire intestine, after which the doctor places a stoma. Hereby the doctor makes an opening in the abdomen (stoma) through which stool from the intestine can pass into a bag. The patient is in fact able to lead a healthy life, although a stoma does require the necessary care.

Complications

If the doctor does not diagnose and treat ileus, life-threatening complications may arise.

Infection

There are bacteria in the intestines. When these end up in the abdominal cavity, peritonitis (peritoneal inflammation) occurs. Peritonitis may cause sepsis (widespread bloodstream infection) with potentially fatal consequences.

Necrosis

Necrosis (tissue death) occurs when the blood does not reach the intestines, causing the intestinal tissue to die and weaken. A weak intestinal wall will rupture faster, causing the intestinal contents to leak out.

Prognosis of bowel disease

The recovery of an ileus depends on the type of treatment for the underlying cause. Ileus is a relatively common condition that is generally easy to treat.

Video: Laparoscopic Lysis of Abdominal Adhesions 2011 (February 2020).

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