Paralytic ileus

　　Paralytic ileus is due to the suppression of intestinal motility after the excitation of the sympathetic nervous system, resulting in the inability of intestinal contents to pass effectively.

　　Common complications of paralytic ileus include constipation, local intestinal necrosis, extravasation hemorrhage, lower gastrointestinal hemorrhage, respiratory and cardiac dysfunction, acidosis caused by central nervous system disorders, metabolic acidosis, intussusception, and intestinal volvulus.

　　The prominent manifestation of paralytic ileus is marked abdominal distension, which often affects the entire abdomen and is usually accompanied by vomiting of gastric contents, without fecal odor. Patients may experience abdominal distension, pain, and discomfort, without the paroxysmal abdominal colic typical of mechanical ileus, due to severe distension causing respiratory distress. Due to significant fluid loss, patients are extremely thirsty and have reduced urine output. Physical examination shows abdominal bulging, disappearance of abdominal breathing, no visible intestinal patterns or peristaltic waves; abdominal tenderness is usually not significant; percussion produces a uniform tympanic sound, the liver dullness border is reduced or disappears; auscultation shows明显 weakened or completely absent bowel sounds. Patients generally have a severe condition but no special pain.

　　There is currently no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of the disease. Appropriate treatment should be given according to the etiology of paralytic ileus, such as gastrointestinal decompression after abdominal surgery or peritonitis, which can improve the condition; for renal colic, antispasmodic analgesics and perinephric blockage can reduce ileus; after the etiology of ovarian cyst pedicle torsion is eliminated, ileus can recover spontaneously, etc.

　　Based on the medical history and clinical manifestations, combined with X-ray, CT and other examinations, the diagnosis can be clarified. During the upright X-ray flat film examination, there is often a phenomenon of gaseous distension of all intestinal loops, and multiple liquid levels can be seen in the intestinal lumen. However, there are also a few cases where only individual intestinal loops occur localized ileus.

　　First, X-ray examination

　　1. Abdominal radiograph shows that the stomach, small intestine, and colon are gaseous and moderately to severely distended. The small intestine can be lightly or heavily gaseous, and the colon is usually more significantly gaseous, often showing the entire colon frame gaseous around the abdomen.

　　2. Abdominal upright radiograph shows the stomach and small intestine, and the colon appear liquid levels of varying widths. Whether the colon stool is granular paste-like or fecal mass, it is a reliable sign to confirm the colon. Patients with acute peritonitis often show signs of peritoneal effusion in abdominal radiographs, and severe cases may also show blurred abdominal fat lines. The intestinal wall thickens due to edema and congestion, and even the diaphragmatic movement is restricted, and the costodiaphragmatic angle becomes obtuse, showing signs of pleural effusion.

　　3. Gastrointestinal contrast study When paralytic ileus is mild, a follow-up examination is performed 3-6 hours after taking the medicine, and the iodine agent can mostly enter the colon, excluding mechanical ileus in the small intestine. When paralytic ileus is severe, the contrast agent can also descend very slowly, and after taking the medicine for 3-6 hours, it still stays in the stomach and duodenum, and the upper part of the jejunum.

　　Second, CT scan

　　Imaging shows that the stomach, small intestine, and colon are all distended with gas, with the changes in the colon being more obvious, with liquid levels visible. Compared with mechanical ileus, the lumen of dynamic ileus is widely expanded but less severe in degree.

　　Non-surgical therapy is the main treatment for paralytic ileus, in addition, traditional Chinese medicine can be used to promote intestinal peristalsis. The mechanism of action is not very clear, but after a large number of clinical verifications, it has been proven that traditional Chinese medicine can stimulate the intestines to restore peristalsis.

　　The 'Fuzheng Liqi Decoction' has excellent efficacy. The prescription is: 15g of Taiizi参, 9g of Zhiqu, 12g of Xuanfugen, 9g of Jiangbanxia, 9g of Qingpingchen, 9g of Guangmuxiang, 15g of Yanhusuo, 30g each of Guma and Maiya, 30g of蒲公英, boiled for half an hour to form a 200ml solution, injected into the intestinal tract through a catheter at the end of surgery, or administered orally to the patient 2-3 hours after surgery. After this treatment, the bowel sounds usually recover within 10 hours after surgery, and the patient can pass gas within 1-2 days.

　　Paralytic intestinal obstruction is a type of intestinal obstruction caused by the temporary cessation of normal intestinal contraction and movement. The following will introduce the specific treatment methods.

　　1. Treatment of the primary diseaseAppropriate treatment should be carried out according to the pathogenic cause of paralytic intestinal obstruction, such as gastrointestinal decompression after abdominal surgery or peritonitis, which can improve the condition; for renal colic, antispasmodic analgesia and perinephric closure can reduce intestinal paralysis; after the elimination of causes such as ovarian cyst pedicle torsion, intestinal paralysis can recover spontaneously, etc.

　　2. Non-surgical treatment:It is the main treatment method for paralytic intestinal obstruction.

　　(1) Drug treatment

　　The use of various parasympathetic nervous system stimulants, such as physostigmine, neostigmine, pituitrin, etc., has certain therapeutic effects on the prevention and treatment of paralytic intestinal obstruction.

　　(2) Gastrointestinal decompression

　　Insert a duodenal tube through the nose and perform continuous aspiration and decompression, and maintain it until automatic anal排气 and normal intestinal peristalsis sound. When abdominal distension subsides, 30ml of castor oil can also be injected into the intestinal lumen through the catheter. If it can cause strong intestinal peristalsis and automatic defecation through the anus, it indicates that intestinal paralysis has been relieved, and the gastrointestinal decompression catheter can be removed.

　　(3) Application of spinal anesthesia or lumbar sympathetic nerve block

　　The suppression of splanchnic sympathetic nerves to treat paralytic intestinal obstruction can usually achieve certain therapeutic effects, but this suppression of visceral nerves is temporary and does not have a lasting effect.

　　(4) Other methods that can stimulate intestinal peristalsis

　　The intravenous infusion of 75-100ml of 10% hypertonic saline solution or 300ml of 10% hypertonic saline enema has a stimulating effect on intestinal peristalsis. Oral hot water also has a certain effect on stimulating intestinal peristalsis. Cold compress on the abdominal wall can also cause a strong intestinal peristalsis.

　　3. Surgical treatment:Most patients with paralytic intestinal obstruction can be cured by non-surgical treatment. However, in cases where non-surgical therapies such as gastrointestinal decompression fail, or when mechanical or strangulated intestinal obstruction cannot be ruled out, enteral decompression and fistulization may occasionally be considered.