Ileus

Ileus is a partial or complete non-mechanical blockage of the small and/or large intestine.

Description

There are two types of intestinal obstructions, mechanical and non-mechanical. Mechanical obstructions occur because the bowel is physically blocked and its contents can not pass the point of the obstruction. This happens when the bowel twists on itself (volvulus) or as the result of hernias, impacted feces, abnormal tissue growth, or the presence of foreign bodies in the intestines.

Unlike mechanical obstruction, non-mechanical obstruction, called ileus or paralytic ileus, occurs because peristalsis stops. Peristalsis is the rhythmic contraction that moves material through the bowel. Ileus is most often associated with an infection of the peritoneum (the membrane lining the abdomen). It is one of the major causes of bowel obstruction in infants and children.

Another common cause of ileus is a disruption or reduction of the blood supply to the abdomen. Handling the bowel during abdominal surgery can also cause peristalsis to stop, so people who have had abdominal surgery are more likely to experience ileus. When ileus results from abdominal surgery the condition is often temporary and usually lasts only 48–72 hours.

Ileus can also be caused by kidney diseases, especially when potassium levels are decreased. Heart disease and certain chemotherapy drugs, such as vinblastine (Velban, Velsar) and vincristine (Oncovin, Vincasar PES, Vincrex), also can cause ileus. Infants with cystic fibrosis are more likely to experience meconium ileus (a dark green material in the intestine). Over all, the total rate of bowel obstruction due both to mechanical and non-mechanical causes is one in one thousand people (1/1,000).

Causes and symptoms

When the bowel stops functioning, the following symptoms occur:

• abdominal cramping
• abdominal distention
• nausea and vomiting
• failure to pass gas or stool

Diagnosis

When a doctor listens with a stethoscope to the abdomen there will be few or no bowel sounds, indicating that the intestine has stopped functioning. Ileus can be confirmed by x rays of the abdomen, computed tomography scans (CT scans), or ultrasound. It may be necessary to do more invasive tests, such as a barium enema or upper GI series, if the obstruction is mechanical. Blood tests also are useful in diagnosing paralytic ileus.

Barium studies are used in cases of mechanical obstruction, but may cause problems by increasing pressure or intestinal contents if used in ileus. Also, in cases of suspected mechanical obstruction involving the gastrointestinal tract (from the small intestine downward) use of barium x rays are contraindicated, since they may contribute to the obstruction. In such cases a barium enema should always be done first.

Treatment

Patients may be treated with supervised bed rest in a hospital, and bowel rest—where nothing is taken by mouth and patients are fed intravenously or through the use of a nasogastric tube. A nasogastric tube is a tube inserted through the nose, down the throat, and into the stomach. A similar tube can be inserted in the intestine. The contents are then suctioned out. In some cases, especially where there is a mechanical obstruction, surgery may be necessary.

Drug therapies that promote intestinal motility (ability of the intestine to move spontaneously), such as cisapride and vasopressin (Pitressin), are sometimes prescribed.

Alternative treatment

Alternative practitioners offer few treatment suggestions, but focus on prevention by keeping the bowels healthy through eating a good diet, high in fiber and low in fat. If the case is not a medical emergency, homeopathic treatment and traditional Chinese medicine can recommend therapies that may help to reinstate peristalsis.

Prognosis

The outcome varies depending on the cause of ileus.

Prevention

Most cases of ileus are not preventable. Surgery to remove a tumor or other mechanical obstruction will help prevent a recurrence.