Ileus

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

Ileus - Symptoms

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

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 ).

Links

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

External links

• Ileus from the surgeon's point of view — interactive algorithm + test
• As. MD Petr Růžička: Ileotic sudden abdominal events E-learning