Corpus: Ileus

An ileus is an obstruction of the intestine that leads to a cancellation of the intestinal passage. The clinical picture is life-threatening and generally requires immediate hospitalisation and often surgical treatment.

A clinically not yet fully developed ileus is referred to as a subileus.

Note: In the English-language literature, mechanical ileus is often differentiated from paralytic ileus as "(intestinal) obstruction", which is referred to as "ileus".

According to ICD-10, ileus can be coded as follows:

• K56: Paralytic ileus and mechanical ileus without hernia
  • K56.0: Paralytic ileus
  • K56.1: Invagination
  • K56.2: Volvulus
  • K56.3: Gallstone ileus
  • K56.4: Other obturation of the intestine
  • K56.5: Intestinal adhesions with ileus
  • K56.6: Other and unspecified mechanical ileus
  • K56.7: Ileus, unspecified

...by cause[Bearbeiten]

• Mechanical ileus: Ileus due to a mechanical obstruction
• Paralytic ileus: Ileus due to intestinal paralysis

The transition from a mechanical ileus to a paralytic ileus is fluid. As a mechanical ileus progresses, it regularly leads to intestinal paralysis. The transitional stage is also referred to as mixed ileus. The final stage of untreated mechanical ileus is paralytic ileus.

...according to localisation[Bearbeiten]

• Small intestinal ileus: Localised in the small intestine
• Large bowel ileus: Localised in the large bowel

...according to patient age[Bearbeiten]

• Ileus in the newborn (meconium ileus)
• Ileus in the child
• Ileus in adults

The causes of mechanical and paralytic ileus differ. However, since any mechanical ileus can lead to paralytic ileus, the entire range of possible causes must be considered clinically in the latter.

Mechanical ileus[Bearbeiten]

Obstruction ("narrowing of the intestinal lumen")[Bearbeiten]

• Intestinal tumour
• Crohn's disease

Obturation ("narrowing of the intestinal lumen from the inside")[Bearbeiten]

• Foreign body
• Gallstone e.g. on the Bauhin valve
• bezoar
• faecal stones
• Meconium

Strangulation ("strangulation of the bowel")[Bearbeiten]

• Brides (so-called bridenileus)
• Adhesions (adhesion ileus)
• Incarceration of a hernia
• Intestinal intussusception
• Volvulus

Paralytic ileus[Bearbeiten]

• Peritonitis
  • in gastric, intestinal or gallbladder perforation
  • in the context of acute pancreatitis
  • after abdominal surgery (postoperative paralytic ileus)
  • migratory peritonitis
  • diverticulitis
• poisoning
  • uraemia
  • Opiate intoxication
• Intestinal ischaemia (e.g. mesenteric infarction)
• Renal colic ("reflex ileus")

The main symptom of mechanical ileus is cramp-like abdominal pain ("colic"). In paralytic ileus, on the other hand, the pain is usually mild and there may initially only be a slight, diffuse tension in the defence.

Other symptoms may occur:

• Vomiting
• Meteorism (especially with paralytic ileus)
• Retention of wind and stool

The higher the intestinal obstruction, the earlier and more severe the onset of vomiting. In paralytic ileus, vomiting usually does not occur before 24 hours, in colonic ileus it can occur even later.

The full picture of an ileus corresponds to the acute abdomen.

A complication of ileus can be ischaemic intestinal wall necrosis due to vascular compression resulting in peritonitis.

Basic diagnostics[Bearbeiten]

• Anamnesis
• Inspection
• Auscultation of the abdomen
• Palpation of the abdomen
• Digital rectal examination

In a mechanical ileus, loud, often metallic-sounding bowel sounds (hyperperistalsis) can be auscultated. In a paralytic ileus, however, the bowel sounds are absent ("dead silence").

Apparative diagnostics[Bearbeiten]

• Laboratory diagnostics
• X-ray
  • Abdominal X-ray in standing and lying position: Multiple mirror images, "standing" bowel loops
  • Contrast enema
• Sonography: dilated, barely mobile intestinal loops, rope ladder phenomenon
• CT
• MRI

• Ogilvie syndrome
• Colon spasticum
• Toxic megacolon

Medicinal treatment[Bearbeiten]

• Cramp solution with butylscopolamine (e.g. Buscopan^®) - Cave: contraindicated in paralytic ileus!
• Metamizole (e.g. Novalgin^®)
• Diazepam
• Antibiotics i.v.
• Rarely intestinal motility enhancement with mestinon
• Metoclopramide i.v.

Non-drug treatment[Bearbeiten]

• Gastric tube
• Parental nutrition
• Surgery, i.e. surgical removal of the causes of mechanical ileus

Mesenteric infarction is an emergency indication.

• Image source podcast: ©Eberhard Grossgasteiger / Pexels
• Image source for flexicon quiz: © Pixabay / Pexels