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paralytic ileus

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paralytic ileus causes diagnosis treatment Merck Manual

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Paralytic ileus is a temporary failure of intestinal peristalsis due to impaired gut motility, without a physical blockage. It is also called adynamic ileus or intestinal paresis.
Common causes
  • After abdominal surgery, especially laparotomy
  • Opioids and anticholinergic medicines
  • Electrolyte disorders, particularly low potassium
  • Peritonitis, sepsis, pancreatitis, or severe systemic illness
  • Trauma, myocardial infarction, renal failure, hypothyroidism
Features
  • Abdominal distension
  • Nausea, vomiting, anorexia
  • Constipation with absent flatus or stool
  • Quiet or absent bowel sounds
  • Diffuse discomfort rather than colicky pain
Diagnosis Abdominal X-ray or CT typically shows diffuse gaseous dilatation of both small and large bowel, without a transition point. Mechanical obstruction and postoperative complications such as an anastomotic leak or intra-abdominal infection must be excluded.
Management
  • Bowel rest if vomiting or marked distension
  • IV fluids and correction of potassium, magnesium, and other electrolyte abnormalities
  • Stop or reduce causative drugs, especially opioids if feasible
  • Nasogastric decompression for persistent vomiting/distension or aspiration risk
  • Early mobilization and treatment of the underlying cause
  • Nutritional support if prolonged
It is usually supportive management, but a prolonged ileus after surgery needs active evaluation for a complication. Bailey and Love's Short Practice of Surgery, p. 347. The Merck Manual overview also lists drugs, infection, and electrolyte abnormalities as important causes.
Urgent assessment is needed for severe or localized pain, fever, peritonism, tachycardia, rising inflammatory markers, feculent vomiting, or clinical deterioration, as these can suggest obstruction, ischemia, perforation, or intra-abdominal sepsis.
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