Ileus

Ileus, or intestinal obstruction, is one of the forms of sudden abdominal events.

Ileus - Symptoms


In general, 4 main symptoms indicate intestinal obstruction. They are:


 * 1) Abdominal pain (colicky, sharp pain arising from distension or suddenly). More detailed information can be found on the page Types of pain in NPB .
 * 2) Vomiting (initially arising reflexively, later from accumulation of contents).
 * 3) Stoppage of gas and stool ( constipation and flatulence ).
 * 4) Abdominal swelling (we describe it as " belly above niveau ").

Ileus - Types
Based on etiopathogenesis, we distinguish several types of ileus:


 * 1) Mechanical (obturation, volvulus, strangulation ).
 * 2) Neurogenic (paralytic, spastic, mixed).
 * 3) Vascular (occurs due to arterial embolism or venous thrombosis ).

Simple mechanical ileus (obstructive)
Subjectively :


 * Colicky pains, not very strong, the intensity gradually increases (later permanent pain from distension with a decrease in peristalsis).
 * Vomiting (occurs later due to stagnation of bowel contents above the obstruction. The more distal the obstruction, the later it occurs.)

Objectively :


 * Tactile soreness (it is mainly localized in the area of ​​the obstacle. After moving the palpating hand away, the pain disappears).
 * Audible effortful peristalsis.
 * Peristaltic waves (visible on the abdominal wall).

Strangulation ileus
Subjectively :


 * Colicky pains (very strong from the beginning).
 * Vomiting (from the beginning).
 * Flatulence (with stoppage of passing gases and stools; troubles the patient from the beginning of the episode).
 * A mixture of blood and mucus in the stool.

Objectively :


 * Tactile soreness (in the place of the obstacle, does not disappear when the examining hand is moved away).
 * Auscultatory disappearance of peristalsis .
 * A drop in blood pressure, an increase in heart rate, pallor and even cyanosis of the face.

Paralytic ileus
Subjectively :


 * Weaker pains from bowel and abdominal wall distension, colic pains are not present.
 * Gases and stools do not pass.

Objectively :


 * History : we are interested in concurrent renal or biliary colic, post-operative conditions, intoxication, etc.
 * The abdomen is evenly inflated.
 * Aurally "dead silence".
 * The patient is in a relatively good condition (blood pressure, heart rate, body temperature – normal).

Spastic ileus
Spastic ileus is very rare, usually it cannot be distinguished from mechanical ileus (until intraoperatively).

Objectively :


 * Anamnesis : we are interested in concurrent CNS diseases.
 * General condition good (unlike mechanical ileus, which spastic ileus otherwise resembles).
 * The symptoms subside after the administration of an antispasmodic.

Vascular ileus
Subjectively :


 * Sharp to shocking pain.
 * From the beginning reflex vomiting.
 * Loose stool with blood admixture appears.

Objectively :


 * History : we are interested in heart or vascular diseases.
 * Increase in heart rate, decrease in blood pressure.

The pathological basis of ileus and its determination

 * 1) Hernias (it is necessary to visually and palpate the inguinal, femoral and umbilical regions).
 * 2) Adhesions (here it is necessary to pay attention to scars after previous operations; in addition to adhesions, remember the possibility of a hernia in the scar).
 * 3) Tumor (mainly rectosigmoid – colorectal carcinoma ; older age, digestive difficulties – alternating constipation and diarrhoea, resistance, examination per rectum ).
 * 4) Intussusception (especially in children; violent colicky pains, early vomiting, blood and mucus in the stool - "raspberry jelly", palpable resistance under the liver and an empty P lower abdomen - Dance's sign).
 * 5) Biliary ileus (in elderly women with long-term gallbladder problems; pneumobilia on X- ray ).

Related Articles

 * Differential diagnosis of inflammatory and ileous NPB
 * Objective symptoms of sudden abdominal events
 * Subjective symptoms of sudden abdominal events
 * Signs of peritoneal irritation