Paralytic ileus Definition, Reason, Symptoms, Treatment & Prevention
Understanding
The human intestine moves to digest food with peristaltic movements that resemble waves. This movement allows incoming food to continue to travel deeper into the digestive tract to the end, namely the large intestine.
Ileus is a condition when this movement is disrupted so that the process of digesting food is also hampered. Paralytic ileus generally occurs in patients who have recently had bowel surgery.
A person’s paralytic ileus can make food accumulate in certain parts of the intestine. If not treated immediately, this condition can make the intestinal wall widen and is at risk of rupture.
When it is broken, the putrefactive bacteria in the intestine can come out into the abdominal cavity. The result will be a wider infection that threatens the lives of sufferers.
Symptom
Symptoms that commonly occur in paralytic ileus include:
- Abdominal swelling
- stomach cramps
- Stomach feels tight
- Bloating
- Constipation
- Nauseous vomit
Reason
Paralytic ileus generally occurs after a person has had major surgery on the intestines. This type of ileus occurs as a side effect of the surgery.
Apart from surgery, several other conditions can also cause paralytic ileus, namely:
- Bacterial or viral infection that spreads to the digestive tract (gastroenteritis)
- Blood electrolyte imbalance
- Infection of the intestine, eg appendicitis
- Impaired blood flow in the intestine
- Kidney and lung disorders
- Narcotic use
Diagnosis
The diagnosis of paralytic ileus is determined based on the results of medical interviews, physical examination, and also supporting examinations. In medical interviews, generally there will be found symptoms that lead to ileus and also a history of major surgery on the intestine before.
The suspicion of ileus was also strengthened through physical examination in the presence of an enlarged stomach and a stomach that felt tight. On examination with a stethoscope, a decrease in the sound of movement in certain parts of the intestine will be found.
To confirm the diagnosis of paralytic ileus, a series of supporting examinations will then be carried out in the form of:
- X-ray of the stomach, to find out if there is a buildup of gas in certain areas of the intestine.
- Computed Tomography Scan ( CT -scan), will provide a detailed picture of the segment of the intestine that is experiencing ileus. CT scans that are performed generally use a dye or contrast agent that is inserted by mouth or by infusion.
- Ultrasonography (USG), is done by attaching a probe to the stomach to determine the location of the intestine that is experiencing ileus. Ultrasound is generally performed on children and pregnant women.
- Barium enema, a type of examination performed by inserting barium sulfate dye through the anus. This dye will fill up to the large intestine. Using an X-ray of the abdomen, it will show fluid accumulation in certain segments of the intestine, where the paralytic ileus occurs.
Treatment
Treatment of paralytic ileus can include non-operative and operative measures.
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Non-operative
Paralytic ileus requires intensive treatment in the hospital. Sufferers can be given drugs that will stimulate bowel movements, such as metoclopramide.
Meanwhile, to reduce pressure in the intestine, a nasogastric tube will be inserted. This tube is placed through the nose and into the stomach. The purpose of the installation is to remove excess fluid, food and gas in the digestive tract. To ensure adequate fluid intake and prevent dehydration, patients are also given additional fluids through an IV.
Paralytic ileus caused by a history of previous surgery generally improves within 2–4 days after the operation. However, in some cases, surgery is required to treat the paralytic ileus that occurs.
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operative action
The operation is carried out by cutting and removing the affected part of the intestine. The remaining end of the intestine will be connected to the outside of the stomach and then a special bag is installed that holds the remaining digested food. Installation of this bag is called an ostomy.
Complications
Paralytic ileus, which is in a severe condition and is not treated promptly, can lead to several complications, such as necrosis and peritonitis.
Necrosis occurs when a part of the intestine dies due to ileus. Intestinal cell death has the potential to make the intestinal wall brittle and break easily. Rupture of the intestine will make the bacteria in the intestine come out into the abdominal cavity. Infection that spreads to the abdominal cavity is called peritonitis.
Bacterial peritonitis can make the sufferer experience a severe infection or sepsis which is potentially life-threatening.
Prevention
Paralytic ileus caused by conditions in the intestine and due to intestinal surgery is actually very difficult to prevent. Someone who undergoes this operation is expected to fully understand the risk of ileus in the future and know the exact signs.
By catching the symptoms of paralytic ileus at an early stage and treating it immediately, various complications later on can be more optimally avoided.