Intestinal paralysis flaccid paralysis

Introduction Paralytic ileus, also known as non-dynamic intestinal paralysis, 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, causing the dilatation of the intestine to disappear. It is not possible to push the contents of the intestines forward. The main symptoms are abdominal distension, symptoms of infection such as fever, examination of abdominal abdomen drum sound, if there is necrotic exudation may be combined with ascites, percussion may have mobile dullness, auscultation of bowel sounds weakened or disappeared.

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. can cause or abnormal blood electrolytes (such as hypocalcemia or hypercalcemia, hypokalemia, low sodium) For other reasons, there are certain drugs. There are often varying degrees of intestinal paralysis between 24 and 72 hours after abdominal surgery.

an examination

Related inspection

Gastrointestinal CT examination

X-ray inspection

(1) Abdominal plain film: Abdominal plain film shows:

1 The stomach, small intestine and colon have a slight to severe expansion of inflation. 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 spleen; the gas in the lying position is more common in the transverse colon and the sigmoid colon (Fig. 1A). 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 continuous in a 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 even the lateral movement is limited, and the signs of pleural effusion.

(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 medication, the iodine can enter the colon and exclude the small intestinal mechanical intestinal obstruction. When the paralytic ileus is severe, the contrast agent can also be extremely slow, and it stays in the stomach and duodenum and the upper jejunum after taking the drug for 3-6 hours.

2. CT scan

The images showed that the stomach, small intestine, and colon were all inflated, and the colonic changes were more obvious. The liquid level was seen. Compared with mechanical intestinal obstruction, the dynamic intestinal obstruction was extensively dilated, but to a lesser extent. The cause of dynamic intestinal obstruction is complicated. In addition to intra-abdominal lesions, abdominal wall lesions can also cause reflex intestinal swelling. After treatment, the inflated expansion of the intestines gradually reduced. If combined with intestinal wall edema, ascites, pneumoperitoneum and other manifestations of peritonitis, continue to observe the primary cause to provide clinical treatment.

3.MRI

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

Differential diagnosis

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. Paralytic ileus is not sensitive to some Chinese medicine diarrhea drugs.

Toxic intestinal paralysis is mainly caused by bacteria and viruses and their toxins causing gastrointestinal dysfunction, resulting in weakened or disappeared intestinal peristalsis, gas accumulation in the intestine, increased pressure, gastrointestinal blood circulation disorders, insufficient blood supply and oxygen supply, forming a vicious circle. Severe bloating can affect cardiopulmonary function, appear or aggravate breathing difficulties.

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