Ileus (Intestinal paralysis)

Adynamic ileus (ileus by inhibition) is characterized by absence of motility, due to neuromuscular inhibition with sympathetic hyperactivity. It is very common and arises after almost all abdominal techniques. Motility reappears in the small intestine at 24 hours, in the stomach at 48, and in the colon over the course of three to five days. Other causes are intraperitoneal inflammatory processes, retroperitoneal pictures, pneumonia, hypokalemia, hypomagnesmia, sepsis, opiates and other causes. Spastic ileus caused by uncoordinated hyperactivity is rare, seen in uremia and heavy metal poisoning, and characterized by sustained muscle wall contracture. Ileus by vascular occlusion arises when the intestine cannot generate movements because of ischemia.

Clinical manifestations

They include anorexia, occasional hypoactive bowel sounds, and perhaps bloating and tympanism. Laboratory studies should include SMA7 profile, calcium and magnesium measurements, complete hematocrit, and amylase measurement. X-rays are sometimes useful in diagnosis, as they show diffuse gas throughout the intestine. Small bowel barium studies are also very useful. Rarely, massive colic ileus (Ogilvie syndrome) culminates in perforation of the cecum.

Treatment

It is important to treat the primary injury! Severe distension sometimes requires a short or long nasogastric tube. Metoclopramide, cisapride, and domeperidone are sometimes helpful.

Fever

They may announce infections, inflammation, neoplasms, or autoimmune disorders. It is usually due to infection. Almost all of the latter are polymicrobial with anaerobes and aerobes. Fever is common in Crohn's disease. Only 10 to 20% of postoperative fevers depend on infections: most often lung, urinary, wound and thrombophlebitis. Other causes include tumors, acalculous cholecystitis, and hepatitis.