Ileus

Ileus is a condition where the normal muscle contractions of the intestines, known as peristalsis, temporarily slow down or stop completely. This prevents food, fluid, and gas from passing through the digestive tract, causing a backup that can lead to a buildup of pressure and potential complications. Unlike a mechanical blockage, such as from a tumor or scar tissue, ileus is a functional problem with the bowel's movement.

Common causes

While most cases of ileus are temporary and resolve on their own, a variety of factors can disrupt normal bowel function.

  • Surgery: The most common cause is abdominal or pelvic surgery, where handling the intestines can trigger a temporary paralysis known as postoperative ileus.

  • Medications: Certain drugs, especially opioid pain relievers, can slow down or paralyze intestinal movement. Other medications like antidepressants and some anticholinergics can also be a factor.

  • Infections and inflammation: Infections inside the abdomen, such as appendicitis or pancreatitis, can disrupt bowel function. Generalized body infections (sepsis) can also cause ileus.

  • Electrolyte imbalances: Low levels of important minerals like potassium can interfere with the nerves and muscles that control the intestines.

  • Medical conditions: Health issues like diabetes, kidney or lung disease, and certain neurological disorders can all cause ileus.

  • Reduced blood flow: Conditions that decrease blood supply to the intestines can damage the nerves and muscles responsible for peristalsis.

Signs and symptoms

Symptoms of ileus develop because of the accumulation of gas and fluids in the intestines.

  • Abdominal bloating and swelling: A buildup of contents in the intestines leads to a noticeable distension of the abdomen.

  • Nausea and vomiting: As pressure builds, a person may feel sick to their stomach and vomit. The vomit may contain greenish or yellowish-green fluid.

  • Constipation: Because the intestines are not moving properly, it becomes difficult or impossible to pass stool.

  • Inability to pass gas: Similarly, the lack of intestinal movement prevents gas from exiting the body.

  • Abdominal pain and cramping: Patients often experience discomfort and pain, which can be constant and dull rather than the intense, wave-like cramping of a mechanical blockage.

  • Loss of appetite: You may feel full quickly and have little desire to eat.

Diagnosis

A doctor will use a variety of methods to diagnose ileus and rule out more serious mechanical blockages.

  • Physical exam: The doctor will ask about your symptoms and medical history. During the exam, they will listen to your abdomen with a stethoscope. The absence of or very faint bowel sounds is a key sign of ileus, unlike the loud sounds heard with an early mechanical blockage.

  • Imaging tests:

    • X-ray: An abdominal X-ray can show gas and fluid buildup in the intestines.

    • CT scan: A more detailed CT scan can confirm the absence of a mechanical obstruction and provide information about the extent of the ileus.

  • Blood tests: These can check for infections or electrolyte imbalances that might be causing the issue.

Treatment

Treatment for ileus focuses on supportive care while addressing the underlying cause. Most cases are temporary and get better within a few days.

  • Bowel rest: A key component of treatment is to stop all oral intake of food and fluids. This "rests" the intestines and allows them to recover.

  • Intravenous (IV) fluids: Because you won't be eating or drinking, fluids and nutrients will be given through an IV to prevent dehydration and correct any electrolyte imbalances.

  • Nasogastric (NG) tube: If bloating and vomiting are severe, a tube may be passed through the nose into the stomach to suction out air and fluid, relieving pressure.

  • Medication management: If certain medications like opioids are a factor, your doctor will adjust or stop them. In some cases, drugs may be used to stimulate bowel movement, but they have proven to be largely ineffective.

  • Treating the underlying cause: The doctor will treat any conditions contributing to the ileus, such as infections or other medical issues.

  • Activity: Mild movement, like walking around when possible, can help stimulate the bowels.

  • Surgery: Surgery is rarely needed for ileus but may be required if the condition persists or if a mechanical blockage is suspected.

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