Alternate Names: Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus

Causes and Risks: Obstruction of the bowel can occur either from ileus (a non-mechanical obstruction) or mechanical causes. Paralytic ileus is one of the major causes of obstruction in infants and children. The causes of paralytic ileus may include:

• Medications, especially narcotics (morphine-like drugs)
• Intraperitoneal infection
• Mesenteric ischemia (decreased blood supply to the support structures in the abdomen)
• Injury to the abdominal blood supply
• After intra-abdominal surgery
• Kidney or thoracic disease
• Metabolic disturbances (such as decreased potassium levels)

• Hernias
• Postoperative adhesions or scar tissue
• Impacted feces (stool)
• Gallstones
• Tumors blocking the intestines
• Granulomatous processes (abnormal tissue growth)
• Intussusception (a condition where the intestine "telescopes" in on itself), volvulus (a twisted intestine)
• Foreign bodies (ingested materials that obstruct the intestines)

Prevention: Prevention depends on the cause. Treatment of conditions (such as tumors and hernias) that are related to obstruction may reduce the risk. Some are not preventable.

Symptoms:

• Abdominal fullness, gaseous
• Abdominal distention
• Abdominal pain and cramping
• Vomiting
• Failure to pass gas or stool (constipation)
• Diarrhea
• Breath odor

Signs and Tests: Listening to the abdomen with a stethoscope may show high-pitched bowel sounds at the onset of mechanical obstruction. If the obstruction persists to long or the bowel is significantly damaged the bowel sounds decrease until they become silent. Paralytic ileus has decreased or absent bowel sound initially.

Tests that show obstruction include:

• Barium enema
• Abdominal CT scan
• Upper GI and small bowel series
• Abdominal film

Treatment: The objective of treatment is to decompress the intestine with suction, using a nasogastric tube inserted into the stomach or intestine. This will relieve abdominal distention and vomiting.

Surgery to relieve the obstruction may be necessary if decompression by nasogastric tube does not relieve the symptoms, or if strangulation of the bowel or gangrene is suspected.

Prognosis: The outcome varies with the cause of the obstruction.

Complications:

• Infection
• Gangrene of the bowel
• Perforation (hole) in the intestine

Call your health care provider if persistent abdominal distention develops with inability to pass stool or gas, or if other new symptoms develop.