Paralytic ileus

Paralytic ileus is a problem with the intestines. Do you all know about this disease? In daily life, we don’t encounter this disease very often, so many people fail to discover it in time when they have this disease. The most obvious symptom of this disease is obvious abdominal distension, and vomiting symptoms will also occur. You should do some examinations in time.

Paralytic ileus has become a common disease. There are many reasons for this disease. Sometimes the abdomen is subjected to some mechanical stimulation during surgery, and inflammatory stimulation in the abdominal cavity can cause paralytic ileus.

The occurrence of paralytic ileus is often related to the following conditions:

1. Mechanical stimulation during abdominal surgery

During surgery, the patient's peristaltic function is temporarily lost due to the traction and stimulation of the intestinal tract and its mesentery, or there is uncoordinated peristalsis in the intestinal wall.

2. Inflammatory stimulation in the abdominal cavity

Peritonitis caused by various reasons, especially diffuse peritonitis, often causes intestinal paralysis and even abdominal distension.

3. Nerve reflex stimulation

Reflex intestinal paralysis can occur in various types of strangulation pain, such as renal colic, biliary colic, colic caused by omental torsion, ovarian cyst pedicle torsion and spermatic cord strangulation.

4. Damage to the chest, abdomen or spinal central nervous system can lead to intestinal gas, fluid accumulation and abdominal distension.

5. Retroperitoneal lesions

Infection, bleeding, tumors, etc. can also cause intestinal paralysis to varying degrees.

6. Mesenteric lesions

For example, mesenteric vascular obstruction, tumors, torsion, etc. can all cause intestinal paralysis due to obstruction of nerve impulse transmission to the intestinal wall.

7. Others

Long-term ether anesthesia, overstretched plaster vest immobilization, and infections in other parts of the extra-abdominal area, such as pneumonia, meningitis, or various sepsis, can occasionally cause reflex intestinal paralysis.

Clinical manifestations

The prominent manifestation of paralytic ileus is marked abdominal distension of the entire abdomen, often accompanied by vomiting of gastric contents without a fecal odor in the vomit. The patient cannot sit up and has difficulty breathing. Due to the massive loss of body fluids, you feel extremely thirsty and your urine output decreases. Physical examination: The abdomen is distended, abdominal breathing disappears, and no intestinal pattern or peristaltic waves can be seen; abdominal tenderness is usually not significant; percussion shows uniform tympanic sound, and the boundary of liver dullness is reduced or disappeared; bowel sounds are significantly weakened or completely disappeared during auscultation. The patient's general condition is often serious, but there is no special pain.

examine

1. X-ray examination

(1) Abdominal plain film ① The stomach, small intestine and colon are inflated and slightly to severely dilated. Intestinal inflation can be mild or severe, while colon inflation is usually more significant, often manifested as inflation of the entire colon frame around the abdomen. ② Abdominal upright plain film: fluid levels of varying widths appear in the dilated stomach, small intestine, and colon. ③ Whether the colon stool is granular or in the form of lumps, it is a reliable sign to confirm the colon. ④ Patients with acute peritonitis often show signs of peritoneal effusion in abdominal plain films, and in severe cases, the abdominal fat line may also be blurred. ⑤ The intestinal wall becomes thickened due to edema and congestion, and there may even be signs of pleural effusion such as restricted diaphragmatic movement and blunting of the costophrenic angle.

(2) Gastrointestinal angiography: When paralytic ileus is mild, repeat the examination 3 to 6 hours after taking the medicine. Most of the iodine can enter the colon, thus ruling out mechanical intestinal obstruction of the small intestine. When paralytic ileus is more severe, the contrast agent may also move downward very slowly and remain in the stomach, duodenum, and upper jejunum 3 to 6 hours after taking the drug.

2. CT scan

The images show that the stomach and small intestine and colon are all inflated and dilated, with the changes in the colon being more obvious. Liquid levels can be seen. Compared with mechanical intestinal obstruction, the intestinal cavity of dynamic intestinal obstruction is widely dilated but to a lesser degree.

4 Diagnosis

The diagnosis can be made based on the patient's medical history, clinical manifestations, and combined with X-ray, CT and other examinations. When taking an upright X-ray, all the intestinal loops are often dilated and inflated, and multiple fluid levels may be seen in the intestinal cavity. However, there are a few cases in which only individual intestinal loops suffer from localized intestinal paralysis.

5 Differential Diagnosis

This disease should be differentiated from mechanical intestinal obstruction. The latter is often related to diseases such as intestinal obstruction, congenital malformation of the small intestine and extraintestinal compression. The main clinical manifestations are paroxysmal abdominal colic and hyperactive bowel sounds on auscultation. Paralytic intestinal obstruction is mostly characterized by persistent bloating and pain, no colic attacks, and weakened or absent bowel sounds. X-ray examination shows that the inflated intestinal lining is of different sizes in mechanical intestinal obstruction; in paralytic intestinal obstruction, general inflation of the gastrointestinal tract can be seen, and the size of the inflated intestinal loops of the small intestine is relatively uniform.

Paralytic intestinal obstruction must be treated promptly after it occurs. General treatments include drug therapy and gastrointestinal decompression. Generally, surgery is not required and the disease can be cured. However, if treatment fails for some patients, surgical treatment should still be considered. At the same time, special attention should be paid to diet and scientific care measures should be taken to avoid the onset of the disease.