Ileus - Intestinal Obstruction

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Ileus - Intestinal Obstruction
Ileus - Intestinal Obstruction
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Ileus (bowel obstruction)

In the case of an ileus (also: intestinal obstruction) there is a complete or incomplete (subileus) disruption of the further transport of the intestinal contents. The reason is occlusion / narrowing / obstruction or paralysis of the intestine. The ileus can be based on, for example, a hernia that constricts the intestine or a tumor. An ileus can also occur as a result of surgical scars (ankle ileus, adhesion ileus).

In the case of an ileus, the intestinal contents are not transported or absorbed as they should - but not at all (ileus) or only partially (subileus). A backlog occurs and as a result symptoms such as nausea, vomiting and severe abdominal pain.

A quick diagnosis and treatment is therefore necessary in order to avoid serious complications. Depending on the location and severity, an immediate operation is usually necessary. In certain situations, a conservative attempt at therapy can be made, for example by giving infusions to balance fluids and electrolytes, refraining from ingesting food and fluids through the stomach and inserting a gastric tube for relief.

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  • What are the causes of an ileus?
  • What are the symptoms?
  • How is the diagnosis made?
  • How is the treatment carried out?
  • Whom can I ask?

What are the causes of an ileus?

Various causes can lead to an ileus:

  • Decreased contraction or paralysis of the intestinal wall muscles (paralytic ileus). This can occur, for example, as a result of inflammation (e.g. inflammation of the pancreas, appendicitis), as a result of a surgical procedure (postoperative ileus), metabolic-related (e.g. hypokalaemia, diabetes mellitus), as a result of taking certain medications (e.g. opioids, opioid-induced constipation, opioid-induced ileus), in tumors or reduced blood flow etc. (One also speaks of functional ileus, paralytic ileus, spastic ileus.)
  • External or internal obstruction or narrowing of the intestine (mechanical ileus). This can occur, for example, as a result of a rupture with trapping of a section of the intestine with a circulatory disorder (incarcerated hernia), a narrowing due to inflammation, adhesions or internal scarring (brides), an obstruction of the intestine due to intestinal tumors, foreign bodies, feces or gallstones (obstruction), a narrowing due to the invagination of one section of the intestine into another (intussusception) as well as a twisting of a section of the intestine (strangulation).

The stagnation and build-up of the intestinal contents with mechanical ileus leads to increased gas formation in the intestine and an overstretching of the intestinal wall in front of the obstacle, which initially leads to a reflex increase in bowel movement. With increasing stretching, the tension in the intestinal wall and the normal intestinal movements (peristalsis) decrease. In paralytic ileus, the paralysis of the intestinal muscles is the cause of the stagnation of the intestinal contents and thus occurs at the beginning. In the case of an intestinal obstruction in the upper sections of the intestine, the food pulp is pushed back into the stomach and vomiting occurs. If there is an obstruction in the intestine further away from the stomach, the pressure in the affected areas increases and it can lead to a circulatory disorder in the affected intestinal tissue.In the worst case, this can die and lead to serious complications (peritonitis) and life-threatening situations (with high fever, circulatory failure, sepsis). With an intestinal obstruction, the body loses a lot of fluid either through reflex vomiting or through the increased loss of fluid in the intestine.

Intestinal obstruction can be acute or chronic. The small or large intestines can be affected.

What are the symptoms?

The symptoms depend, among other things, on the cause, location and how advanced the ileus is. For example:

  • Belching, nausea, vomiting,
  • Abdominal pain (depending on the stage and cause: colicky, attack-like, but also permanent pain; with intestinal paralysis, the pain may be slight or nonexistent),
  • Meteorism (accumulation of air and gas in the gastrointestinal area, distended abdomen),
  • Bowel behavior (constipation) and
  • Miserere (vomiting of feces, with advanced ileus).

If the closure is incomplete, the symptoms also slowly increase.

Note Symptoms such as abdominal pain are often difficult to classify for those affected. In the event of certain symptoms (e.g. severe pain, rapid deterioration in general condition, shortness of breath, accelerated breathing, palpitations, drop in blood pressure, etc.), medical help must be called immediately (emergency number 144)!

How is the diagnosis made?

Diagnosis is based on anamnesis and various examinations such as inspection, palpation (palpation) of the abdomen, auscultation (listening) to intestinal noises. In connection with the diagnosis, the duration and type of complaints, previous illnesses, previous operations, taking medication etc. are important.

  • Ultrasound of the abdomen,
  • Blank x-ray of the abdomen, x-ray with oral contrast agent administration or rectally applied contrast agent,
  • CT of the abdomen
  • possibly endoscopy as well
  • various laboratory values ​​(infection values, electrolytes, kidney values, etc.)

How is the treatment carried out?

The treatment is based on the individual situation. For mild complaints, medication, infusions to balance fluids and electrolytes as well as food and fluid abstinence may be sufficient. Enemas can be made. With the help of a nasogastric tube, the gastrointestinal area can be relieved and the contents of the stomach removed. In addition, air can be released using an intestinal tube.

If the diagnosis results or symptoms are severe, such as severe pain and high fever, it is necessary to operate. Causes such as adhesions, incarcerations or strangulation of the intestine etc. can be eliminated in this way. It may also be necessary to remove parts of the intestine if they are damaged or dead. An artificial anus may also be necessary temporarily.

Corresponding pain therapy is carried out parallel to the therapeutic measures.

Whom can I ask?

Contact persons for complaints in the gastrointestinal area are:

  • Family doctor
  • Specialist in surgery
  • Specialist in internal medicine (gastroenterology)

In the case of an ileus, hospitalization is often necessary. The acute treatment takes place in the hospital (e.g. department for surgery, alternatively also department for internal medicine with a focus on gastroenterology).

Symptoms of an ileus can be difficult for those affected to classify. In the event of certain symptoms (e.g. pain, diarrhea, vomiting, constipation, fever, blood in the stool), medical help should be sought immediately. In the event of (increasing) severe pain, rapid deterioration in the general condition, shortness of breath, accelerated breathing, palpitations, drop in blood pressure, etc., medical help must be called immediately (emergency number 144)!

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