Ileus

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

Ileus - Symptoms[edit | edit source]

Surgical treatment of ileus


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[edit | edit source]

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)[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

  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 ).

Links[edit | edit source]

Related Articles[edit | edit source]

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

External links[edit | edit source]