Paralyzing intestinal obstruction (paralytic ileus)

A paralyzing intestinal obstruction suddenly stops the intestinal movement (peristalsis). Due to intestinal paralysis, the intestinal contents can no longer be transported toward the rectum. As with mechanical intestinal obstruction, the germs in the intestinal contents can migrate through the intestinal wall. They get into the abdominal cavity and lead to peritonitis. It comes to a so-called acute belly (acute abdomen).

Paralyzing intestinal obstruction as a result of peritonitis

Conversely, an existing peritonitis can also lead to a paralyzing intestinal obstruction. Rapid (acute) and long-lasting (chronic) inflammatory processes in the abdominal organs can spread to the abdominal cavity due to wall damage to the affected organ and also cause a severe inflammatory reaction in the abdominal cavity or the peritoneum (peritonitis).

Irrespective of the cause of peritonitis, a paralyzing intestinal obstruction (paralytic ileus) develops due to peritonitis. The intestinal loops are no longer able to move the intestinal contents.

What causes paralytic ileus?

In this form of intestinal obstruction, the intestinal lumen is not narrowed. The passage of the stool is impeded by metabolic, toxic or reflex intestinal paralysis (= paralysis).

Particularly inflammatory gastrointestinal diseases lead to a paralyzing intestinal obstruction via peritonitis:

• a perforated stomach or small intestine ulcer (perforated gastric or duodenal ulcer)
• Inflammation of the gallbladder (acute cholecystitis)
• Inflammation of the pancreas ( acute pancreatitis )
• Perforated inflammation of an intestinal bulge (perforated diverticulitis )
• dangerous complication of ulcerative colitis (toxic megacolon)
• contagious gastrointestinal inflammation (acute infectious gastroenteritis)
• Appendicitis (acute appendicitis)

Paralytic ileus: Other causes

Aside from inflammatory diseases, the blockage of one of the most essential abdominal arteries can also be responsible for a paralyzing bowel obstruction. Two important arteries branch off the aorta (main artery) in the abdominal cavity and supply blood to almost the entire small and large intestine. These are the upper and lower intestinal arteries (superior and inferior mesenteric arteries). Like all arteries in the human body, these are also subject to an arteriosclerotic process in old age. Closure of one of these vessels leads to what is known as a mesenteric infarction.

Das von den Mesenterialarterien abhängige Darmgewebe kann nicht mehr ausreichend mit Blut und Sauerstoff versorgt werden. Diese schwerwiegende Durchblutungsstörung führt zum Absterben des Darms. Die Darmwände werden durchlässig, und der Inhalt der Darmschlingen kann ungehindert in die Bauchhöhle wandern. Das Bauchfell entzündet sich, und es bildet sich ein lähmender Darmverschluss (paralytischer Ileus) aus.

Older people are mostly affected. Changes in blood salts can also lead to a paralyzing intestinal obstruction. Blood salts (electrolytes) are responsible for the muscles, including the intestinal muscles, to contract and thus carry out the desired movement—changes in the potassium value, in particular, lead to such changes. Furthermore, due to a vertebral fracture, the intestine can react with (temporary) paralysis. Therefore, patients with vertebral fractures must eat light food for a few days to minimize the risk of intestinal paralysis.