Ileus

Ileus is often referred to as intestinal obstruction or loss of intestinal propulsion. Simply put, it is a condition, where the guts can not move.

Causes

According to causes, ileus can be divided into three basic types – mechanical, neurogenic and vascular.

Mechanical ileus

In this case, there is present bowel obstruction due to an obstacle. This obstacle may be a foreign object (a large gallstone, a swallowed object, etc.) or the intestine itself (intestinal strictures, compression from the outside, etc.).

Neurogenic ileus

In neurogenic ileus, the bowel motility disorder results from disturbed function of neurons of the intestinal wall leading to loss of peristalsis. It should be noted that this condition can either occur primarily, or it occurs as the last phase of virtually any other types of ileus.  

Vascular ileus

This is a very insidious and lethal form of ileus caused by closure of some of the blood vessels supplying the intestine. Sudden lack of oxygen damages a part of the intestine and disrupts its motility.

Symptoms

Regardless of the underlying cause, the main problem is the stoppage of stool movement and its accumulation in certain parts of the intestine. This usually leads to abdominal pain, vomiting and signs of constipation. The symptoms may differ according to the area of intestinal obstruction.  If the failure of propulsion is located in the upper part of the intestines, the patient begins to suffer from vomiting and the bowel movements (defecation) may be present for some time. On the contrary, when the problem is in the lower part of the intestines, the primary symptom is the stoppage of defecation and vomiting occurs with a delay. Such vomiting contains extensively digested lower intestinal content with a very unpleasant odor resembling feces (referred to as “miserere”).

 

The accumulation of stool is probably the most dangerous aspect of ileus conditions. The stool accumulates, dilates the intestine and compresses its wall causing local ischemia. The intestinal wall looses its barrier function and allows the local bacteria to penetrate into the abdominal cavity causing bacterial peritonitis and septic condition. Advanced forms of ileus therefore manifest with symptoms of a cardiovascular shock including cold sweat, palpitations, rapid breathing, low blood pressure, impaired consciousness, coma, and eventually death.

 

More specific information about the symptoms can be found in texts related to current types of ileus (see above in “Causes”).

Diagnosis

When there is a suspicion of an ileus, the patient should be examined by a surgeon. Palpation and listening proves signs of the so-called “acute abdomen” such as rigidity of the abdominal wall, abdominal pain during palpation and percussion and the absence of peristaltic sounds. Simple abdominal X-ray is very valuable as it shows specific image of fluid levels typical for ileus conditions. Further diagnostic approach depends on the clinical suspicion (abdominal ultrasound, computed tomography, angiography, diagnostic laparoscopy, etc)

Treatment

The therapy depends on the cause of intestinal obstruction. Any obstacle must be removed, usually by a surgical intervention. Neurogenic ileus is poorly treatable and the procedure is rather conservative with administration of prokinetic drugs. Vascular ileus can be treated by endovascular or surgical approach with removing the arterial closure, if possible.