Neurogenic Ileus

Neurogenic ileus is a type of intestinal obstruction. The condition is quite serious and it can have some fatal consequences.

Causes

The condition is caused by a stoppage of stool movement, i.e. the intestines stop moving. This situation is not caused by an obstruction (like in mechanical ileus), but by disrupted function of intestinal nervous system. We distinguish the paralytic ileus (frequent) and spastic ileus (rare). Paralytic ileus means an overall weakening of the intestinal activity. In spastic ileus, the intestine is cramped with the same result.

 

Spastic ileus occurs only rarely and it may be caused by some neurological diseases and hormonal disorders. The details shall not be discussed in this article and we rather move to the much more frequent and clinically important paralytic ileus.

 

Paralytic ileus may occur as a primary disorder (in such case its reasons are usually not entirely clear), but mainly it is a final stage of all other types of intestinal obstruction. For example, when there is a mechanical ileus, the obstruction of the intestine causes periodic contractions of the intestinal muscles that try to overcome the obstacle. However, after certain time, the muscles get tired and the contractions stop leading to development of paralytic ileus. Therefore, paralytic ileus accompanies practically all cases of acute abdomen – perforated peptic ulcer, acute pancreatitis, intestinal perforation, etc. Paralytic ileus may develop n patients with infections within the abdominal cavity and in critically-ill patients in intensive care units.

 

Paralytic ileus follows the majority of abdominal surgeries, but the paralysis usually withdraws within days after the surgical intervention.

Symptoms

The symptoms of the paralytic ileus are initially relatively inconspicuous. The bowel movements disappear and the patient usually suffers from the loss of appetite and limited abdominal pain. The abdomen is distended and rigid. Later, the patient begins to vomit and as the prolonged paralytic ileus causes loss of barrier function of the intestinal wall, intestinal bacteria penetrate into the abdominal cavity causing peritonitis, sepsis and eventually death.

Diagnosis

The patient should be examined by a surgeon. It is important to know any previous diseases that may be associated with the development of paralytic ileus. Physical examination of the abdomen is essential – the palpation and percussion may be slightly painful and we hear no sounds of bowel movements when listening with a stethoscope. Abdominal X-ray may show classic sign of ileus, i.e. characteristic air and fluid levels.

Treatment

The treatment is difficult. If possible, it is necessary to treat the underlying condition and administer fluids by parenteral infusions. Medication supporting intestinal movement (prokinetic agents) may be also useful. Infectious complications are treated by antibiotics.