Paralytic ileus

Introduction Also known as non-dynamic intestinal paralysis, it affects the balance of the intestinal autonomic nervous system for various reasons, or affects the local nerve conduction in the intestine, or affects the contraction of the smooth muscle of the intestine, so that the intestinal tube dilatation and peristalsis disappear, and the intestine cannot be The content is pushed forward and caused. As with mechanical intestinal obstruction, paralytic ileus also stops the movement of intestinal contents in the intestine. However, unlike mechanical intestinal obstruction, paralytic ileus obstruction is significant, and there is no manifestation of peristalsis such as paroxysmal colic. On the contrary, intestinal peristalsis is weakened or disappeared, and rarely causes intestinal perforation.

Cause

Causes of paralytic ileus: secondary to severe intra-abdominal infection, retroperitoneal hemorrhage, major abdominal surgery, or intra-abdominal blood clot formation to block intestinal blood supply, atherosclerosis or intestinal artery or vein injury And the intestinal blood supply disorders. Extraintestinal diseases such as renal failure, pneumonia, chest thyroid function, intestinal bleeding, ureteral colic, etc. may cause or abnormal blood electrolytes (such as hypocalcemia or hypercalcemia, hypokalemia, low sodium), There are other drugs for other reasons. There are often varying degrees of intestinal paralysis between 24 and 72 hours after abdominal surgery.

1. Mechanical stimulation during abdominal surgery: During the operation, the patient's peristaltic function is temporarily lost due to the stimulation of the intestine and its mesentery, or there is an uncoordinated peristalsis in the intestinal wall, but no intestinal contents are pushed. At the time of rhythm, the patient often has abdominal flatulence after surgery, and sometimes abdominal pain. Generally, the rhythm of intestinal peristalsis returns to normal after 2 to 3 days after surgery, and the intestinal gas and fluid can be smoothly discharged from the body, and the abdominal distension and abdominal pain also disappear.

2. Inflammation in the abdominal cavity: peritonitis caused by various causes, especially diffuse peritonitis, often occurs in intestinal paralysis and even abdominal distension.

3. Neuroreflexive stimulation: Reflex intestinal palsy can occur after a variety of strangling pains, such as renal colic, biliary colic, colic with retinal torsion, ovarian cyst torsion and spermatic cord strangulation.

4. Chest and abdomen or spinal nerve injury: can cause intestinal effusion and abdominal expansion.

5. Retroperitoneal lesions: such as infection with bleeding tumors can also cause varying degrees of intestinal paralysis.

6. Mesenteric lesions: such as mesenteric vascular occlusion, tumor, torsion, etc. can cause intestinal paralysis due to nerve impulse conduction to the intestinal wall.

7. Others: such as long-term ether anesthesia, over-extended plaster vest fixation, and infections in other parts of the abdomen such as pneumonia, meningitis or various sepsis can occasionally cause reflex intestinal paralysis.

an examination

Related inspection

CT examination of angiography

X-ray examination

(1) Abdominal plain film: Abdominal plain film showed: 1 The stomach, small intestine and colon were inflated with mild to severe expansion. Intestinal inflating can be light and heavy, and colon inflation is mostly significant, often manifested as a peritoneal colonic balloon. The standing position is most obvious in the colon of the liver and the spleen. The gas in the lying position is more common in the transverse colon and the sigmoid colon. The small intestine is distributed in the middle abdomen within the colon frame. When the identification is difficult, the lateral fluoroscopy is seen in the anterior abdomen. When the expansion is heavy, the intestinal fistula is in a continuous tubular shape. When the expansion is light, it is a divided inflatable intestinal tube. 2 In the abdomen standing flat film, the divergent stomach and the small intestine and the colon have different liquid levels, and the liquid level can be different, and the liquid level is stationary. Generally, the number of liquid levels is less than that of mechanical intestinal obstruction. 3 Colonic feces, whether it is a granular paste or a fecal mass of feces, is a reliable sign to confirm the colon. 4 acute peritonitis often appear in the abdominal plain film of abdominal effusion sign, severe cases can also appear abdominal fat line blurred. 5 The intestinal wall is thickened by edema and congestion, and there is even a sign of pleural effusion in the transverse movement.

(2) Gastrointestinal angiography: 60% of mesothes 60% orally or by gastric tube. Due to the stimulating effect of the hypertonic iodine solution on the intestinal tract, the amount of fluid in the intestine can be increased, and gastrointestinal motility is promoted. When the paralytic ileus is lighter, after 3 to 6 hours of taking the drug, the iodine can enter the colon, and the mechanical intestinal tract obstruction of the small intestine is more serious. The contrast agent can also go down very slowly. After ~6h, it still stayed in the stomach and duodenum, and in the upper jejunum.

CT scan

The images showed that the stomach and small intestine colon were inflated, and the colonic changes were more obvious. The liquid level was seen. Compared with mechanical intestinal obstruction, the dynamic intestinal obstruction was extensive but less severe. The cause of dynamic intestinal obstruction was complicated except for the intra-abdominal In addition to the lesion, abdominal wall lesions can also cause reflex intestinal swelling. The inflated expansion of the intestines of the patients with improved treatment gradually decreased. If combined with intestinal wall edema, ascites pneumoperitoneum and other manifestations of peritonitis, continue to observe the primary cause to provide clinical treatment.

MRI

There are few reports on MRI applications. The table shows the general expansion of gas, fluid and gas-liquid plane in the stomach, duodenum, small intestine and colon.

Differential diagnosis

The disease should be differentiated from mechanical intestinal obstruction. The latter is often associated with diseases such as intestinal obstruction, congenital malformation of the small intestine and extraintestinal compression. The clinical manifestations are paroxysmal abdominal cramps, and auscultation of bowel sounds is hyperactive; while paralytic intestinal obstruction is mostly persistent pain. , no colic attacks, bowel sounds weakened or disappeared. X-ray examination, the size of the inflatable intestine lining when mechanical intestinal obstruction is different, the paralyzed intestinal obstruction can be seen in the gastrointestinal tract inflation, the small intestine inflatable intestinal fistula size is more consistent.

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