8 Frequently Asked Questions about Ileus

Your intestines constantly perform wave-like muscle contractions called peristalsis. Peristalsis moves food, gas, and fecal matter forward until eliminated from the body. When an area of the intestines stops moving or slows down, this can cause the fecal matter to sit around, creating a buildup or blockage. Ileus is the lack of movement in the intestines which causes this buildup.

Ileus most commonly occurs after a person has had surgery. One reason for this is because post-operative patients are often prescribed medication which may slow intestinal movement. This condition is paralytic ileus. Abdominal surgery can result in intestinal adhesions—fibrous tissue in the abdominal cavity— which can also cause ileus. Other causes of ileus may include:

• Intestinal cancer
• Inflammatory bowel disease, such as Crohn’s disease
• Diverticulitis
• Parkinson’s disease
• A hernia
• Twisting of the colon (volvulus)
• Impacted feces

Ileus does not usually occur in healthy people with no previous medical conditions. Certain conditions increase the risk of developing ileus, and they include:

• Surgery, especially gastrointestinal surgery
• Electrolyte imbalance
• Crohn's disease
• Intestinal cancer
• Abdominal injury
• Drugs (opioids, anticholinergics, sometimes calcium channel blockers)
• Metabolic disturbances

If you think you may have ileus, seek immediate medical attention. Most signs are related to abdominal discomfort. Symptoms include:

• Abdominal cramping
• Abdominal distension
• Loss of appetite
• Constipation
• Nausea, vomiting
• Inability to pass gas
• Excessive burping

When you visit a doctor complaining of abdominal discomfort, you will most likely receive a brief physical examination to determine whether further tests are required. The doctor may listen to your belly with a stethoscope and will ask for your history. You will be asked questions about how you are feeling and about your bowel movements. According to the Mayo Clinic, your doctor may order the following tests or procedures as she deems necessary:

• X-ray. If your doctor suspects intestinal obstruction, you will receive an x-ray to confirm this diagnosis. According to the Mayo Clinic, however, not all obstructions can be seen on an x-ray.
• Computerized tomography (CT). A CT scan provides a more detailed picture than a standard x-ray. It is more likely to show intestinal obstruction if there is one.
• Ultrasound. This method is preferred for children who may have an intestinal obstruction.
• Air or barium enema. For this procedure, air or liquid is inserted into the colon through the rectum. Then, an x-ray image is taken for a clearer picture. Sometimes, the insertion of air or liquid into the colon can fix the intestinal obstruction without further intervention.

If it has been determined that you have ileus, you will be hospitalized. Based on your current situation, your doctor will determine whether to wait and monitor you closely, or whether to intervene with surgery. According to Bert Cagir, MD, FACS, Clinical Professor of Surgery at The Commonwealth Medical College, physiologic ileus after surgery usually resolves within 2-3 days.

• In children with intussusception, a barium or air enema is the first line of treatment, according to the Mayo Clinic.
• Partial obstruction may not require intervention. The patient may be given intravenous fluids (IV), as well as a low-fiber diet which is easier on the intestines.
• Complete obstruction is a medical emergency, and it may require surgery. The obstruction will be removed as well as any intestinal tissue which may be dead or damaged.
• If you are not strong enough for surgery, or if you have colon cancer, the doctor may opt to treat the complete obstruction with a self-expanding metal stent. The stent may be inserted into the colon via endoscope or mouth. It then forces the colon open so that the obstruction may clear.
• If you are suffering from paralytic ileus due to a medication, you may be given another medication to stimulate motility. If possible, you may be taken off the medication which caused the paralytic ileus.

Ileus can lead to a life-threatening medical condition if left untreated. These are some of the conditions that may arise: Necrosis is cell injury which results in the permanent death of cells in living tissue. This can happen if the obstruction cuts off blood supply to the intestine. It can lead to bowel perforation. Bowel perforation is when a hole or a tear occurs in the intestine. When this happens, fecal matter— which contains high levels of bacteria—can leak into the abdominal cavity. Peritonitis is inflammation and infection in the abdominal cavity caused by bacteria or fungus. This is a result of bowel perforation, as mentioned above. Peritonitis can turn into a life-threatening condition called sepsis, which can put a person into shock or multiple organ failure.

Their overall health largely determines the outlook for patients who experience ileus. If the patient has colon cancer, for example, he may be treated periodically with a self-expanding metal stent, and not with surgery. The global mortality rate of healthy patients who did not survive an ileus (due to complications which arose from this condition) is 3.8 out of every 100,000. If you are otherwise healthy and you seek treatment, you will most likely make a full recovery.