General Medical Information

Adynamic Ileus

David M. Barrs

Ileus is much more common after abdominal procedures than after head and neck procedures. The otolaryngologist, however, must certify that there is intestinal motility before beginning postoperative feeding, especially hyperosmolar tube feeding. Adynamic ileus should be suspected in any patient with constipation, prolonged vomiting, abdominal pain and distention, or an absence of bowel sounds. Abdominal radiographs show a diffuse gas pattern and distended loops of bowel. The most common cause is the perioperative administration of pharmacologic agents, including anesthetic agents, opioids, anticholinergics, calcium channel blockers, and antihistamines. The differential diagnosis must include hypokalemia, distal obstruction (e.g., fecal impaction, neoplasm), sepsis, and an acute abdominal event, such as exacerbation of diverticulosis. Endoscopy or contrast enema may be necessary to rule out bowel obstruction. The treatment is directed at the underlying cause. The patient usually responds to supportive measures of avoidance of oral intake, administration of i.v. fluids, and nasogastric suction. Sympathetic blockade or parasympathetic stimulation with bethanechol, neostigmine, or metoclopramide is currently being researched. With these measures, the ileus usually resolves within a period of several days.