A 70yo man had a right hemicolectomy for ceacal carcinoma 6days ago. He now has abdominal
distension and recurrent vomiting. He has not opened his bowels since surgery. There are no
bowel sounds. WBC=9, Temp=37.3C. What is the single most appropriate next management?
a. Antibiotic therapy IV
b. Glycerine suppository
c. Laparotomy
d. NG tube suction and IV fluids
e. TPN
answer: D
Paralytic (or adynamic or neurogenic) ileus can be defined as a state of atony of the intestine. Its
principal clinical features are the following:
• abdominal distension.
• absolute constipation.
• vomiting.
• absence of intestinal movements and, hence, absence of colicky pain.
Differential diagnosis
Differentiation of paralytic ileus from mechanical obstruction is based on the following criteria:
• Duration . Paralytic ileus rarely lasts more than 3 or 4 days; persistence of symptoms after this
time is suspicious of mechanical obstruction.
• Bowel sounds . The presence of bowel sounds is important. An absolutely silent abdomen is
diagnostic of paralytic ileus, whereas noisy bowel sounds indicate mechanical obstruction.
• Pain . Paralytic ileus is relatively painless, whereas colicky abdominal pain is present in
mechanical obstruction.
• Timing . If symptoms commence after passage of flatus or had a bowel action, it is very likely that a mechanical obstruction has supervened. The other possibility to consider is that there has been a leakage from an anastomosis and that peritonitis is now present.
Treatment of paralytic ileus is conservative: NGT decompression + Fluids&Electrolytes
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