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Ileus

What is an ileus?

Your intestines are about 28 feet long. This means the foods you eat have a long way to travel before they’re fully digested or excreted. Your intestines complete this task by moving in a wave-like motion. Known as peristalsis, these muscle contractions move forward your digested food. However, if something slows down or blocks this motion, the result can be a major traffic jam in your intestines.

Ileus is the medical term for this lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material. An ileus can lead to an intestinal obstruction. This means no food material, gas, or liquids can get through. It can occur as a side effect after surgery. However, there are other causes of this condition.

An ileus is a serious concern. But people often don’t know that food is building up in their intestines and continue to eat. This pushes more and more material toward the buildup. Without treatment, the ileus can perforate or tear the intestine. This causes bowel contents, which have high levels of bacteria, to leak into areas of your body cavity. This can be deadly. If an ileus does occur, it’s important to get treatment as quickly as possible.

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Symptoms

What are the symptoms of an ileus?

An ileus can cause extreme abdominal discomfort. Symptoms associated with ileus include:

  • abdominal cramping
  • appetite loss
  • feeling of fullness
  • constipation
  • inability to pass gas
  • stomach swelling
  • nausea
  • vomiting, especially vomiting stool-like contents

Gastrointestinal symptoms are the most common signs of an ileus. Your stomach and intestines will start to fill with gas that can’t pass out the rectum. This causes the abdomen to take on a tight and swollen appearance.

If you experience these symptoms, especially after surgery, it’s important to seek immediate medical attention.

Causes

What are the causes of an ileus?

An ileus is common after surgery because people are often prescribed medication that can slow intestinal movement. This is a type of paralytic ileus. In this instance, the intestine isn’t blocked. Rather, it isn’t moving properly. The result is little or no movement of digested food through your intestines.

Examples of medicines that can cause a paralytic ileus include:

  • hydromorphone (Dilaudid)
  • morphine
  • oxycodone
  • tricyclic antidepressants, such as amitriptyline and imipramine (Tofranil)

However, there are several other causes of an ileus. These include:

These are the most common ileus causes in adults. Children can also have an ileus. According to the Mayo Clinic, intussusception is the most common cause for an ileus in children. This is when a part of the intestine “telescopes” or slides into itself.

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Risk factors

Risk factors for ileus

Ileus is the second most common reason for hospital readmission in the first 30 days after surgery. An ileus is more likely if you’ve recently had abdominal surgery.

Surgical procedures on the abdomen that involve handling the intestines commonly cause stoppage of intestinal movement for a period of time; this allows the surgeon to access your intestines. Sometimes normal peristalsis can be slow to return. Other people are more likely to experience later scar tissue formation that can also lead to an ileus.

A number of medical conditions can increase your risk of ileus. They include:

  • electrolyte imbalance, such as those involving potassium and calcium
  • history of intestinal injury or trauma
  • history of intestinal disorder, such as Crohn’s disease and diverticulitis
  • sepsis
  • history of irradiation of or near the abdomen
  • peripheral artery disease
  • rapid weight loss

Aging also naturally slows down how fast the intestines move. An older adult is at greater risk for ileus, especially since they tend to take more medications that could potentially slow movement of material through the intestines.

Diagnosis

How is an ileus diagnosed?

A doctor would first listen to a description of your symptoms. You’ll likely be asked about any history of medical conditions, prescribed medications, and surgeries, especially recent procedures. Your doctor will then conduct a physical exam, looking at your abdomen for signs of swelling or tightness. Your doctor will also listen to your abdomen for typical bowel sounds with a stethoscope. If your bowels aren’t moving because of an ileus, your doctor may not hear anything, or may hear excessive bowel sounds.

Imaging studies are usually ordered after a thorough physical exam. A doctor may use these methods to identify areas where bowel content seems to be concentrated. Imaging studies can show where an ileus is located, likely showing a buildup of gas, an enlarged intestine, or even obstruction. Examples of imaging studies include:

  • plain film X-ray: This may show signs of trapped gas and possibly the obstruction, but plain film X-rays aren’t always the most conclusive way to diagnose an ileus.
  • CT scan: This scan provides more detailed X-ray images to help doctors identify the potential area where the ileus is located. The scan typically uses contrast agents injected intravenously or taken orally.
  • ultrasound: This imaging technique is more commonly used to identify an ileus in children.

In some instances, a doctor may use a diagnostic procedure known as an air or barium enema. A doctor will insert air or barium sulfate, a radioopaque substance, through the rectum into the colon, while a technician takes X-rays of the abdomen. The air or barium shows up on the X-ray to help the technician view any potential obstruction. In some children, this procedure can treat an ileus that is caused by intussusception.

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Complications

What complications can an ileus cause?

An ileus can develop into a serious and potentially life-threatening situation. Two of the most severe complications are:

Necrosis

Also known as untimely cellular death or dead tissue, necrosis can happen when an obstruction cuts off blood supply to the intestine. Without blood, oxygen can’t get the tissue, causing it to die. Dead tissue weakens the intestinal wall. This makes it easy for the intestine to tear and leak bowel contents. This is known a bowel perforation.

Peritonitis

The bowel perforation mentioned earlier can cause peritonitis. This is a serious inflammation in the abdominal cavity caused by bacteria or fungus. Your bowel contains many bacteria, like E. coli. They are supposed to remain in your intestines, not roam free in your body cavity. Bacterial peritonitis can turn into sepsis, a life threatening condition that can result in shock and organ failure.

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Treatments

How is an ileus treated?

Treatments for an ileus depends on its severity. Examples include:

Partial obstruction

Sometimes a condition like Crohn’s disease or diverticulitis will mean that part of the intestine isn’t moving. But some bowel material can get through. In this instance, if you are otherwise stable, a doctor may recommend a low-fiber diet. This can help reduce the bulky stool, making it easier to pass. However, if that doesn’t work, surgery to repair or move the affected portion of the bowel may be needed.

Complete obstruction

A complete obstruction is a medical emergency. Treatment will depend upon your overall health. For example, some people can’t handle an extensive abdominal surgery. This includes the very elderly and those with colon cancer. In this case, a doctor may use a metal stent to make the intestine more open. Ideally, food will start to pass with the stent.

Abdominal surgery to remove the blockage or the damaged intestine portion may still be needed though.

Paralytic ileus

Treatment for a paralytic ileus starts by identifying the underlying cause. If medicine is the cause, a doctor may be able to prescribe another medication to stimulate motility (intestine movement). An example is metoclopramide (Reglan). Discontinuing the medications that caused the ileus, if possible, can also help. However, you shouldn’t stop taking a medicine, especially an antidepressant, without your doctor’s approval.

Treatment without surgery is possible during the early stages of paralytic ileus. But you may still require a hospital stay to get the proper fluids until the issue is fully resolved. A doctor may also use a nasogastric tube with suctioning, in addition to giving intravenous fluid hydration. Known as nasogastric decompression, this procedure calls for a tube to be inserted into your nasal cavity to reach your stomach. Essentially the tube suctions out the extra air and material that you may otherwise vomit.

Most surgery-related ileus will resolve within two to four days after surgery. However, some people do require surgery for correction if the condition doesn’t improve.

Considerations for surgery

Your intestines are very long, so you can live without a portion of it. While it may affect the digestive process, most people do live a healthy life with a part of their intestine removed.

In some instances, a doctor may have to remove the entire intestine. In this case, a doctor will create a special pouch called an ostomy. The bag allows stool to drain from your remaining gastrointestinal tract. You have to care for the ostomy, but you can live without your intestine after an ileus.

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Outlook

Outlook for ileus

An ileus is common, but it’s highly treatable. If you’ve had a recent surgery, or have other risk factors for an ileus you should be aware of the symptoms. Seeking medical care is important in the hopes the ileus can be resolved without invasive medical treatment.

Prevention

Can an ileus be prevented?

Most of the risk factors associated with ileus aren’t preventable. Examples include an injury or chronic illness. If surgery is necessary, the possibility for ileus should be considered. But it shouldn’t keep you from having a needed surgery.

Being aware of the symptoms of an ileus are important in seeking prompt treatment to keep it from getting worse. 

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