From the Guidelines
Paralytic ileus is primarily caused by abdominal surgeries, particularly those involving bowel manipulation, as well as post-operative inflammation, electrolyte imbalances, and certain medications, including opioid pain medications and anticholinergics. The condition can also be triggered by infections within the abdomen, neurological disorders, and certain medical conditions like hypothyroidism and Parkinson's disease. According to the most recent study 1, postoperative ileus is one of the most frequent complications after abdominal surgery, with a multifactorial pathophysiology that depends on multiple parameters related to the patient, procedure, and perioperative care.
Some of the key causes of paralytic ileus include:
- Abdominal surgeries, especially those involving bowel manipulation
- Post-operative inflammation
- Electrolyte imbalances, such as hypokalemia, hypomagnesemia, and hypocalcemia
- Medications, including opioid pain medications, anticholinergics, calcium channel blockers, and some antipsychotics
- Infections within the abdomen, such as peritonitis or severe systemic infections leading to sepsis
- Neurological disorders affecting the autonomic nervous system
- Retroperitoneal hemorrhage or trauma
- Prolonged bed rest with inactivity
- Certain medical conditions, such as hypothyroidism and Parkinson's disease
As noted in the study 1, the use of opioid pain medications can exacerbate paralytic ileus, especially in patients with intestinal overdistension. The use of thoracic epidural analgesia (TEA) has been associated with a lower incidence of paralytic ileus, attenuation of the surgical stress response, and improved intestinal blood flow. Additionally, the study 1 recommends minimally invasive surgery, optimized fluid management, and opioid-sparing analgesia to prevent postoperative ileus. Early mobilization, early postoperative food intake, laxatives, and omission of postoperative nasogastric tubes may also help minimize the risk of paralytic ileus.
From the Research
Causes of Paralytic Ileus
The causes of paralytic ileus can be diverse and multifactorial. Some of the key causes include:
- Postoperative factors: Paralytic ileus can occur after surgery, particularly after abdominal surgery, spinal surgery, traumatic injury, or lower extremity joint reconstruction 2, 3, 4.
- Opioid use: The use of opioids, especially natural opium alkaloids, has been associated with an increased risk of developing paralytic ileus 5.
- Metabolic disorders: Certain metabolic disorders can contribute to the development of paralytic ileus 6.
- Severe illnesses: Severe illnesses, such as infections or inflammatory conditions, can also lead to paralytic ileus 6.
- Extensive surgery: Extensive surgical procedures, particularly those involving the abdomen or colon, can increase the risk of paralytic ileus 6.
- Medications: Certain medications, such as antikinetic drugs, can inhibit intestinal motility and contribute to paralytic ileus 6.
- Pre-operative factors: Pre-operative chemotherapy, pre-operative antithrombotic drugs, and other factors can increase the risk of paralytic ileus 4.
Risk Factors
Specific risk factors for paralytic ileus include: