Ileus and Pseudo-Obstruction

Question 1

What is Paralytic Ileus?

Answer 1

Functional impairment of bowel motility leading to obstruction
Common post-operative complication

Causes
- post operative
- Intra-abdominal sepsis
- electrolyte imbalance
- drugs e.g. opioids

Question 2

What are clinical features of paralytic ileus?

Answer 2

Abdo pain and distension
Vomiting
Constipation
Distended abdo
Absent or reduced bowel sounds

Question 3

What are investigations and management of paralytic ileus?

Answer 3

CT abdo to exclude obstruction

Management
- NBM
- NGT if vomiting
- IV fluids
- Minimise opioid use

Question 4

What is pseudo-obstruction?

Answer 4

Massive colonic dilatation without mechanical obstruction
Often affects caecum and ascending colon

Causes
- Electrolyte disturbances
- Drugs
Post operative states
Severe systemic illness

Question 5

What are the clinical features of pseudo-obstruction?

Answer 5

Abdo pain and distension
Vomitin
COmplete constipation
Tympanic abdo on percussion
Absent or reduced bowel sounds

Question 6

What are the investigations and management of pseudo-obstruction?

Answer 6

CT scan
- dilatation of colon with no transition point

Management
- Conservative: NBM, IV fluids, decompression, treat underlying cause
- If this fails then endoscopic decompression with flatus tube via flexi sig
- Surgery if perforation, peritonitic or clinical deterioration