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Ileus – Symptoms, Causes, Treatment

Updated on January 16, 2014

What is Ileus?

Ileus is defined as a non-mechanical obstruction of the intestines. It is classified as non-mechanical because the blockage is not physical in nature. That is, it is not due to abnormal tissue growth within the intestines, hernia, impacted feces, foreign material or volvolus which physically blocks the pathway in the bowels. Rather, Ileus is an obstacle that arises when the regular muscle contractions of the bowel stop, hence not permitting the transport of material within the intestines. This wavelike contraction, called peristalsis, pushes the material through the colon. When it stops, material transit is impeded causing the intestine to be distended.

Types of Ileus

Gastrointestinal Atony, which is the other term for ileus, is classified into various types. These are post-operative, paralytic, and acute colonic pseudoobstruction.

  • Postoperative ileus

This occurs after a surgical procedure is performed on the abdomen. The partial paralysis experienced by a particular segment of the intestine is only temporary, and so intake of drinks and food may resume when peristaltic activity is detected.

  • Paralytic ileus

This could be partial or complete paralysis of the intestines which results in blockage since food materials can no longer move forward. The symptoms of paralytic ileus are bloating, constipation and absence of bowel sounds. Though it could be an effect of surgery, this type may also develop from sustaining injuries, certain ailments as well as the use of certain medications.

  • Acute colonic pseudoobstruction

This condition resembles mechanical obstruction of the large bowel. Also referred to as Ogilvie's syndrome, this problem is typified by the dilatation of the hemicolon and cecum, thus, hampering the flow of materials in the intestine.

Causes of Ileus

Various factors can contribute to the development of Ileus, including:

  • Infections

Intra-abdominal infections like appendicitis, diverticulitis and infection of the membrane that line abdomen are a common cause of ileus. In fact, they are the main reason for intestinal obstruction in babies and young kids. Pneumonia, sepsis and blood poisoning are also possible causes.

  • Reduced blood supply

This non-mechanical bowel obstruction can be attributed to decreased or disrupted supply of blood to the abdomen or also known as mesenteric ischemia.

  • Surgery

Surgical procedures in which the intestines are handled may result in the stoppage of peristalsis which leads to ileus. Operation involving the spine or joint can also lead to the stoppage of peristalsis.

  • Hypokalemia

Hypokalemia is a condition that arises when potassium levels are low. This could be due to kidney disease.

  • Drugs

Some drugs, like those used for chemotherapy, and certain narcotics, can increase the risk of developing ileus.

  • Cystic fibrosis

Newborns who suffer from this condition have higher chances of developing meconium ileus.

Trauma or injury, heart attack, electrolyte imbalance, and muscle disorders that affect the proper functioning of the muscles are factors that may lead to ileus.

Symptoms of Ileus

When peristalsis stops and blockage in the bowels develop, several symptoms will be manifested. These include cramping in the abdomen, distention of the bowel, abdominal pain, vomiting, nausea, diarrhea, constipation, flatulence, bloating, hiccups and excessive belching.

Diagnosis of Ileus

Ileus can be diagnosed by the assessment of the symptoms, physical examination as well as the review of the patient’s medical history. With a stethoscope, the doctor will likewise listen to the abdomen to check if there is a bowel sound. Diagnostic tests and procedures, like the following, will confirm the condition.

  • X-rays, CT scan and ultrasound – These imaging procedures will take pictures of the inside of the abdomen and confirm the presence of obstruction in the intestines.
  • Barium enema – This is a more invasive procedure which employs radiation to take an image of the colon.
  • Colonoscopy – This is performed to inspect the lining of the colon. A slim tube with a light at one end is introduced into the colon by way of the rectum.
  • Blood tests – Ileus could also be confirmed with the aid of blood tests.

Treatment of Ileus

When there is obstruction in the intestines it is imperative that nothing is ingested via the mouth. NPO, which means “nil per os” or “nothing by mouth” is a must until the blockage is cleared. In the meantime, the patient will have to take in nutrients intravenously or with the aid of nasogastric tube. The materials will then be evacuated by suctioning. In the severe case in which necrosis of the tissues in the intestines is present, surgery is required.

Supportive treatment is an important part in dealing with ileus. Drugs that enhance intestinal motility such as lactulose, cisapride, vasopressin and neostigmine are employed. Aside from bowel rest, the patient is also subjected to bed rest with constant monitoring.

The cause of ileus must also be dealt with. For instance, if the case is drug-related, the offending medication should be stopped. Other underlying causes, such as infections and electrolyte imbalance, should be treated.

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