Paralytic Ileus: Causes, Diagnosis, Management

April 1, 2002

This obstruction is caused by a failure of intestinal peristalsis;there is no evidence of mechanical obstruction.Paralytic ileus is common after abdominal surgery, especiallyif anticholinergic drugs are given preoperativelyand/or narcotics are used postoperatively. It usually lasts2 to 3 days. Paralytic ileus may also be caused by peritonitis;ischemia or surgical manipulation of the bowel; retroperitonealhemorrhage; spinal fracture; systemic sepsis;shock; hypokalemia; uremia; pharmacologic agents (eg,vincristine, loperamide, and calcium channel blockers);diabetic ketoacidosis; and myxedema.

This obstruction is caused by a failure of intestinal peristalsis;there is no evidence of mechanical obstruction.Paralytic ileus is common after abdominal surgery, especiallyif anticholinergic drugs are given preoperativelyand/or narcotics are used postoperatively. It usually lasts2 to 3 days. Paralytic ileus may also be caused by peritonitis;ischemia or surgical manipulation of the bowel; retroperitonealhemorrhage; 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 distentionand minimal pain, which intensifies with increasing distention.Bowel sounds are generally minimal or absent. Incontrast, mechanical obstructions are associated with hyperactivebowel sounds.Plain abdominal radiographs in patients with paralyticileus demonstrate uniform distribution of gas throughoutthe bowel, including the colon and rectum. In contrast, mechanicalobstructions cause progressive bowel distention,with distended proximal and collapsed distal segments.Management includes nasogastric suction, intravenousfluid administration, and correction of electrolyte imbalance.The underlying cause should be treated if possible.