What Is a Paralytic Ileus?

Paralytic intestinal obstruction, also known as unmotivated intestinal palsy, affects the balance of the intestinal vegetative nervous system for various reasons; or affects local nerve conduction in the intestine; or affects the contraction of intestinal smooth muscles so that the intestinal expansion and peristalsis disappear. Patients with significant abdominal distension, no paroxysmal colic, etc., intestinal motility weakened or disappeared, and rarely caused bowel perforation.

Basic Information

Also known as: Unmotivated intestinal palsy
English name: paralyticileus
Visiting department: surgical
Common causes: Mechanical stimulation during abdominal surgery, inflammatory stimulation in the abdominal cavity, nerve reflex stimulation, and damage to the chest, abdomen, and central spine can cause gas, gas, and bloating in the intestine, retroperitoneal lesions, and mesenteric lesions.

Common symptoms: Bloating, vomiting

Causes of paralytic intestinal obstruction

The occurrence of paralytic intestinal obstruction is often related to the following conditions:

1. Mechanical stimulation during abdominal surgery

During the operation, the peristaltic function of the bowel and its mesentery was temporarily lost after the stimulus was pulled, or the intestinal wall had uncoordinated peristalsis.

2. Inflammatory stimulation in the abdominal cavity

Peritonitis caused by various reasons, especially diffuse peritonitis, often causes intestinal paralysis and even abdominal distension.

3. Nerve reflex stimulation

Reflexive intestinal paralysis can occur after a variety of colic, such as renal colic, biliary colic, colic caused by omental torsion, ovarian cyst pedicle torsion, and spermatic cord strangulation.

4. Injuries to the central nervous system of the chest, abdomen, or spine can cause gas, fluid and bloating in the intestine.

5. Retroperitoneal lesions

Such as infection of bleeding tumors can also cause varying degrees of intestinal paralysis.

6. Mesenteric lesions

Such as mesenteric blood vessel occlusion, tumor, torsion, etc. can be caused by nerve impulses to the intestinal wall blocked and intestinal paralysis occurs.

7. Other

Such as long-term ether anesthesia, overstretched gypsum vest fixation, and infections in other parts of the abdomen, such as pneumonia, meningitis, or various sepsis can occasionally cause reflex intestinal paralysis.

Clinical manifestations of paralytic intestinal obstruction

Paralyzed intestinal obstruction is manifested by obvious abdominal distension of the whole abdomen, and is often accompanied by vomiting stomach contents, and vomiting without fecal smell. The patient cannot sit up and feels breathing hard. Due to the large loss of body fluids, I feel extremely thirsty and have reduced urine output. Physical examination: Abdominal swelling, abdominal breathing disappeared, bowel type and bowel peristaltic waves were not seen; abdominal tenderness was mostly insignificant; percussion showed uniform drum sounds, and liver dullness was reduced or disappeared; bowel sounds were significantly weakened or completely disappeared at the auscultation. Patients are generally more severe, but without special pain.

Paralytic intestinal obstruction

1. X-ray inspection

(1) Plain plain film The stomach, small intestine and colon are inflated with mild to severe dilation. The small intestine inflation can be light or heavy, most of the colon inflation is more significant, often manifested as a full abdominal frame inflation. Abdominal flat film: wide and narrow liquid levels appear in the enlarged stomach, small intestine, and colon. Colonic feces, whether granular or lumpy, are a reliable sign of the colon. Acute peritonitis often shows signs of peritoneal effusion in abdominal plain films, and in severe cases, blurred abdominal fat lines can also appear. The intestinal wall is thickened due to edema and congestion, and even the diaphragmatic movement is restricted, and the pleural angle becomes dull, such as pleural effusion.

(2) Gastrointestinal angiography When the paralytic intestinal obstruction is mild, recheck after 3 to 6 hours after taking the drug, the iodine can enter the colon and exclude the small intestine mechanical intestinal obstruction. When the paralytic intestinal obstruction is more serious, the contrast medium can also go down very slowly, and it still stays in the stomach and duodenum and upper jejunum 3 to 6 hours after taking the drug.

2.CT scan

The image shows that the gastrointestinal and small intestine colons are aerated and dilated, and the colonic changes are more obvious. The liquid level can be seen. Compared with the mechanical intestinal obstruction, the dynamic intestinal obstruction has a wide but mild intestinal dilatation.

Diagnosis of paralytic intestinal obstruction

According to the patient's medical history and clinical manifestations, combined with X-ray, CT and other examination and diagnosis can be clear. When standing X-ray plain film examination, often all intestinal ridges are inflated and dilated, and there are multiple fluid levels in the intestinal cavity. However, there are a few cases of localized intestinal paralysis that occur only in individual bowel loops.

Differential diagnosis of paralytic intestinal obstruction

The disease should be distinguished from mechanical intestinal obstruction. The latter is often related to diseases such as intestinal blockage, congenital malformation of the small intestine, and extra-intestinal compression. The clinical manifestations are mainly paroxysmal abdominal cramps and auscultation of intestinal hyperphonia; paralytic intestinal obstruction is mostly persistent pain. No colic onset, bowel sounds weakened or disappeared. On the X-ray examination, the size of the gastrointestinal lining was different during mechanical intestinal obstruction; the gastrointestinal tract was normal and the small intestinal gastrointestinal tract was more consistent in paralytic intestinal obstruction.

Treatment of paralytic intestinal obstruction

1. Management of the primary cause

Treat the cause of paralytic intestinal obstruction accordingly, such as intestinal paralysis caused by abdominal surgery or peritonitis. After giving gastrointestinal decompression, the condition can be improved. Those with renal colic should be given antispasmodic analgesia and around the kidney capsule. Closure can reduce intestinal paralysis; after the cause of ovarian cyst pedicle torsion is eliminated, the intestinal paralysis can heal itself.

2. Non-surgical Therapy

Is the main treatment for paralytic intestinal obstruction.

(1) Drug treatment Application of various parasympathetic stimulants, such as toxic physostigmine, neostigmine, pituitary hormone, etc., has a certain effect on the prevention and treatment of paralytic intestinal obstruction.

(2) Gastrointestinal decompression The duodenal tube is inserted through the nose, and continuous suction decompression is given, and it is maintained until the anus can automatically exhaust and the bowel motility sound is normal. When the bloating subsides, 30 ml of castor oil can also be injected into the intestine from the catheter. If it can cause strong intestinal peristalsis and automatic discharge of stool in the anus, it means that the intestinal paralysis has been relieved and the gastrointestinal decompression catheter can be removed.

(3) Application of spinal anesthesia or lumbar sympathetic nerve block Inhibition of visceral sympathetic nerves and treatment of paralytic intestinal obstruction can mostly achieve a certain effect, but this inhibition of visceral nerves is temporary and there is no lasting effect.

(4) Other methods to stimulate intestinal peristalsis: Intravenous infusion of 75% to 100ml of 10% hypertonic saline solution or 300ml retention enema of 10% hypertonic saline can both stimulate intestinal peristalsis. Oral hot water has a certain effect on stimulating intestinal peristalsis. A cold compress on the abdominal wall can also cause stronger bowel movements.

3. Surgery

Most patients with paralytic intestinal obstruction can be cured by non-surgical treatment. However, in cases where non-surgical treatment such as gastrointestinal decompression fails, or mechanical or strangulated intestinal obstruction cannot be ruled out, intestinal decompression fistulas may occasionally be considered.