Does motion stop in ileus?

Intestinal Motility in Ileus

Yes, in ileus, intestinal motility stops or is significantly impaired, leading to a functional obstruction of the gastrointestinal tract without mechanical blockage. 1

Definition and Pathophysiology

• Ileus refers to a condition where there is a failure to propel luminal contents through the intestines due to impaired or uncoordinated intestinal muscle contractions, without an organic obstructing lesion 2
• It is characterized by the cessation of bowel motility, which distinguishes it from mechanical obstruction where physical blockage prevents passage of contents 3
• The condition presents with symptoms similar to intestinal obstruction: colicky abdominal pain, nausea, vomiting, abdominal distension, and often a dilated bowel 2

Clinical Manifestations

• Radiological findings typically show slow transit and dilated bowel without a transitional zone 2
• Manometric studies reveal propulsive failure, absence of migrating motor complexes (MMCs), and sometimes giant contractions 2
• Patients may develop significant abdominal distension due to accumulated gas and fluid in the intestinal lumen 4
• Bowel sounds are typically absent or diminished due to the lack of peristaltic activity 1

Types and Causes

• Acute ileus (paralytic or adynamic) is commonly caused by:

  • Abdominal surgery (post-operative ileus) 2
  • Trauma or sepsis 2
  • Metabolic disturbances (e.g., hypokalemia, hypomagnesemia) 2
  • Medications, particularly opioids and anticholinergics 2

• Chronic intestinal dysmotility (lasting >6 months) can result from:

  • Neurological disorders affecting the enteric nervous system 2
  • Myopathic conditions affecting intestinal smooth muscle 2
  • Autoimmune processes with antineuronal antibodies 2
  • Paraneoplastic syndromes 2

Management Approach

• Initial management includes:

  • Maintaining nil per os (NPO) status until bowel function returns 1
  • Nasogastric tube placement for decompression to relieve distension 1
  • Intravenous fluid resuscitation to correct fluid and electrolyte imbalances 1
  • Discontinuing medications that worsen ileus, particularly opioids 1

• Pharmacological interventions:

  • Prokinetic agents such as metoclopramide may be considered to stimulate gastrointestinal motility 1
  • Neostigmine (an anticholinesterase) may be used in persistent cases 1, 3
  • Avoiding antidiarrheal medications which can worsen the condition 1

• Supportive measures:

  • Early mobilization to stimulate bowel motility 1
  • Optimizing fluid management while avoiding overhydration 1
  • Considering thoracic epidural analgesia for pain management instead of opioids in post-operative ileus 1

Complications

• Prolonged ileus can lead to:
  • Bacterial overgrowth in the intestines 4
  • Increased intra-abdominal pressure potentially leading to abdominal compartment syndrome 4
  • Malnutrition and dehydration requiring nutritional support 1
  • Bowel perforation in severe cases 5

Monitoring Recovery

• Signs of resolving ileus include:
  • Return of bowel sounds 1
  • Passage of flatus 1
  • Bowel movements 1
  • Reduction in abdominal distension 3

Common Pitfalls to Avoid

• Continuing opioid medications, which significantly exacerbate ileus 1
• Premature initiation of oral intake before return of bowel function 1
• Failing to correct underlying electrolyte abnormalities that may contribute to dysmotility 3
• Overlooking potential serious complications such as increasing intra-abdominal pressure 4