Paralytic Ileus

This obstruction is caused by a failure of intestinal peristalsis; there is no evidence of mechanical obstruction. Paralytic ileus is common after abdominal surgery, especially if anticholinergic drugs are given preoperatively and/or narcotics are used postoperatively. It usually lasts 2 to 3 days. Paralytic ileus may also be caused by peritonitis; ischemia or surgical manipulation of the bowel; retroperitoneal hemorrhage; spinal fracture; systemic sepsis; shock; hypokalemia; uremia; pharmacologic agents (eg, vincristine, loperamide, and calcium channel blockers); diabetic ketoacidosis; and myxedema.

Paralytic ileus typically presents with abdominal distention and minimal pain, which intensifies with increasing distention. Bowel sounds are generally minimal or absent. In contrast, mechanical obstructions are associated with hyperactive bowel sounds.

Plain abdominal radiographs in patients with paralytic ileus demonstrate uniform distribution of gas throughout the bowel, including the colon and rectum. In contrast, mechanical obstructions cause progressive bowel distention, with distended proximal and collapsed distal segments.

Management includes nasogastric suction, intravenous fluid administration, and correction of electrolyte imbalance. The underlying cause should be treated if possible.