Ileus (intestinal blockage): symptoms, cause and treatment

Ileus or bowel obstruction symptoms include abdominal pain, nausea, vomiting and severe bloating. Ileus is the cessation of normal intestinal transit. Ileus is also called intestinal obstruction or intestinal blockage. Such an intestinal blockage can be caused by a part of the intestine being partially or completely closed off. This is called a mechanical ileus or mechanical occlusion. It may also be that the muscles of the intestinal wall no longer contract. This is called a functional closure. Various causes can underlie an ileus. If you suspect an intestinal blockage, you will be immediately admitted to hospital for treatment. Once the ileus has cleared, you usually recover quickly. The prospects are generally good.

  • What is an ileus?
  • Intestinal blockage
  • Ileus and sub-ileus
  • Causes of an ileus
  • Mechanical ileus or obstructive ileus
  • Paralytic ileus or paralysis ileus
  • Symptoms of an ileus
  • General symptoms of obstructive ileus
  • First symptoms of obstructive ileus
  • Symptoms of paralytic ileus
  • Risk factors
  • Complications
  • Dead tissue
  • Infection
  • Other
  • Examination and diagnosis
  • Interview and physical examination
  • Visual art investigation
  • Ileus or intestinal blockage treatment
  • Hospitalization
  • Operation
  • Medication
  • Diet
  • Recovery
  • Prognosis

 

The gastrointestinal tract: 1. esophagus, 2. stomach, 3. small intestine, 4. appendix, 5. cecum, 6. ascending colon (left), transverse colon (horizontal), descending colon (right), 7. rectum, 8. anus / Source: Edelhart Kempeneers, Wikimedia Commons (Public domain)

What is an ileus?

Intestinal blockage

Through gastrointestinal movements or peristalsis, the digesting food is propelled from the beginning to the end of the gastrointestinal tract, that is, from the stomach to the rectum. When the passage of food in the intestine is stopped or obstructed, this is called ‘ileus’, also called an ‘intestinal blockage’ or ‘intestinal obstruction’. Food cannot leave the body as stool, resulting in serious complaints. Without further treatment, the condition is life-threatening.

Ileus and sub-ileus

An ileus can occur in both the small intestine (enteron) and the large intestine (colon). A complete bowel obstruction is called an ileus and partial obstruction is called a sub-ileus.

Causes of an ileus

There are various causes for ileus, which can be roughly divided into two main groups:

  • Mechanical ileus or obstructive ileus; and
  • Paralytic ileus or paralysis ileus.

 

Mechanical ileus or obstructive ileus

Mechanical ileus occurs because the intestine is physically blocked and the intestinal contents cannot flow through the digestive tract normally. For example, the intestine may be closed by a tumor in the intestine, by scar tissue (adhesions) or by a twist in the intestine (volvulus). The intestine tries with increasing force to squeeze the food past the narrowing through violent contractions.
Causes
Possible causes are:

  • an intussusception, where part of the intestine slides into the next part of the intestine;
  • a twisting of the intestine (volvulus);
  • diverticular disease;
  • a hernia: an abnormal bulging of the intestines through a weak part of the abdomen, whereby the bulging intestine can become trapped in the opening;
  • an inflammatory bowel disease of the intestine, such as Crohn’s disease;
  • fecal impaction, or a very severe degree of intestinal blockage (constipation);
  • gallstones;
  • tumors in the intestines such as colon cancer;
  • scar tissue and adhesions in the abdomen, sometimes caused by surgical intervention in the abdominal or pelvic area (a very common cause of ileus);
  • foreign bodies (objects that you swallow and block the intestines).

 

Paralytic ileus or paralysis ileus

In this form, the intestine itself no longer moves, and peristalsis is no longer present. Because the intestine is at a standstill, food accumulates. It is caused by intense irritation of the intestine, for example due to peritonitis, pancreatitis, an abscess in the abdomen, a side effect of medications or as a complication of anesthesia after major abdominal surgery. This causes the abdomen to swell and one experiences moderate pain (unless the inflammation is very painful). The patient is nauseous and vomits slightly. There are no stools or wind. Conditions outside the gastrointestinal tract can also cause ileus, such as renal insufficiency or abnormal electrolyte levels.
Causes
Possible causes of defective nerves and muscles that cause the intestines to come to a standstill are:

  • acute renal failure;
  • postpartum period;

Paralytic ileus as a side effect of medication / Source: Jarmoluk, Pixabay

  • Parkinson’s disease;
  • diabetic ketoacidosis;
  • acute myocardial infarction;
  • stroke;
  • abdominal or pelvic surgery;
  • lung disease;
  • respiratory infection;
  • kidney disease;
  • trauma;
  • reduced blood flow to the intestines;
  • abnormal electrolyte levels, for example low potassium or high calcium;
  • viral or bacterial gastroenteritis (stomach flu);
  • severe form of an underactive thyroid gland (hypothyroidism);
  • taking certain medications, such as tricyclic antidepressants and opioid painkillers;
  • abdominal infections, such as peritonitis or appendicitis.

 

Stomachache / Source: Andrey Popov/Shutterstock.com

Symptoms of an ileus

General symptoms of obstructive ileus

The complaints depend on the type of ileus. The symptoms of an obstructive ileus are:

  • attacks, cramping, increasingly severe abdominal pain (colic), because the intestine tries to squeeze the food with increasing force through the narrowing;
  • a swollen abdomen;
  • a painful feeling when pressing on the abdomen;
  • vomiting, the vomit will smell more and more like feces the longer the closure lasts;
  • the complete absence of winds and stools;
  • the violent contraction movements of the intestine can be clearly visible from the outside;
  • lots of bowel sounds (sink murmurs);
  • bad breath (halitosis), for example an odor of poop.

 

First symptoms of obstructive ileus

In the case of an obstructive ileus that is the result of a slowly growing tumor, the complaints often develop gradually. The first complaints often consist of:

  • varying intestinal cramps;
  • decreased appetite;
  • changed stool pattern;
  • swelling of the abdomen.

The moment the closure is complete, the picture described earlier emerges.

Symptoms of paralytic ileus

The symptoms of a paralytic ileus include:

  • moderate abdominal pain that is permanently present;
  • a swollen abdomen;
  • nausea and vomiting;
  • the absence of stools and wind;
  • there are no bowel movements or bowel sounds at all (‘silent abdomen’).

 

Radiotherapy (irradiation) in the abdomen is a risk factor for intestinal obstruction / Source: Adriaticfoto/Shutterstock.com

Risk factors

Diseases and conditions that can increase the risk of a bowel obstruction include:

  • Abdominal or pelvic surgery, which often leads to adhesions that can lead to a blockage;
  • Crohn’s disease, which can lead to thickening of the walls of the intestine, narrowing the passage;
  • Cancer in the abdomen, especially if you have had surgery or radiotherapy to remove an abdominal tumor.

 

Complications

Left untreated, an ileus can lead to serious, life-threatening complications, including:

Dead tissue

An intestinal obstruction can cut off the blood supply to part of the intestine. The intestinal wall can die from a lack of blood. Dead tissue can lead to a tear (perforation) in the intestinal wall, which can lead to infection.

Infection

Peritonitis is the medical term for peritonitis. It is a life-threatening condition that requires immediate medical and often surgical treatment.

Other

Dehydration, electrolyte imbalance and jaundice are other complications of intestinal obstruction.

CT scan / Source: IStock.com/Pavel Losevsky

Examination and diagnosis

Interview and physical examination

The doctor will ask questions about your medical history and the complaints you have. He will also perform a physical examination to assess the situation. The doctor may suspect an intestinal obstruction if your abdomen is swollen and tender. He then listens to the intestine with the stethoscope and assesses the intestinal sounds.

Visual art investigation

In addition to history and physical examination, the diagnosis is based on X-ray examination with contrast fluid. Examination can be done with the contrast agent barium in combination with air, which makes the colon clearly visible on the X-ray images. Sometimes additional imaging tests are necessary, such as a CT scan or MRI scan.

Ileus or intestinal blockage treatment

Hospitalization

If an intestinal blockage is suspected, the patient is often admitted to hospital without delay. The first requirement is that nothing is taken by mouth. The patient therefore receives an infusion for fluid balance. A gastric tube is also placed to remove excess intestinal fluid.

Operation

In most cases of mechanical ileus, surgery is required to remove the obstruction. Surgical intervention removes or repairs the blockage and/or removes the part of the intestine with the obstruction. After removal of the affected part of the intestine, the two ends are sutured together and sometimes you will receive a stoma after the operation, an artificial exit for stool through the abdominal wall. This usually concerns a temporary stoma that is created to promote the healing of the intestine.
The elderly or those with colon cancer may not be suitable candidates for extensive surgery. Instead, they can receive a stent, a flexible, metal tube that is placed endoscopically. The stent is placed through the narrowing in the large intestine and will then unfold. This allows the stool to pass again and the intestinal blockage is resolved.

Medication

For paralytic ileus, treatment depends on the cause. If certain medication is the cause, it is stopped or reduced. Intestinal peristalsis can be stimulated by medication.

Diet

In the case of sub-ileus, the complaints can possibly be reduced by adjusting your diet. The diet depends on the precise location of the ileus. Consult a dietitian or ask your doctor for (nutritional) advice. For adhesions in the intestine, the doctor can prescribe a fiber-rich diet, ground fiber-rich food or a low-fiber and liquid diet. This depends on the location of the adhesions: in the small intestine, a liquid and low-fiber diet is recommended and for adhesions that are more localized towards the large intestine, a fiber-rich diet is becoming increasingly important.

Recovery

After surgery, intestinal function usually returns to normal within 5 days. If it lasts longer than five days, it is considered disturbed peristalsis (paralytic ileus). Recovery from an ileus depends on getting the right treatment for the underlying cause.

Prognosis

Ileus is a relatively common condition that is easily treated. It mainly occurs in those who have had recent abdominal or pelvic surgery.

read more

  • Pain when defecating: stabbing or burning pain during bowel movements
  • Blocked intestines: causes, symptoms, self-care, treatment
  • Abdominal pain in the lower abdomen: left/right, causes in men and women
  • Vomiting (vomiting): causes of vomiting and nausea
  • Intestinal complaints: abdominal swelling, abdominal pain and flatulence
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