| Theme |
Diagnosis and Treatment of Intestinal Obstruction: Timing in Consulting a Surgeon |
| Title |
Paralytic Ileus Due to Acute Pancreatitis |
| Author |
Yutaka Suzuki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Nobutugu Abe |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Tadahiko Masaki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Toshiyuki Mori |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Masanori Sugiyama |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Yutaka Atomi |
Department of Surgery, Kyorin University School of Medicine |
| [ Summary ] |
Paralytic ileus is a frequent complication in patients with acute pancreatitis. Paralytic ileus is caused by sympathetic reflex due to the spread of infection to the bowel and the mesenterium, attenuation of peristalsis by CCK or secretin, circulatory failure of the bowel and the mesenterium, reaction to bacteriotoxins or inflammatory cytokines. Diagnostic imaging is the leading tool in diagnosing this condition although sentinal loop signs and colon cut-off signs in X-rays are important for the evaluation of clinical progress. Surgery is not indicated for paralytic ileus. However, ileus-induced bacterial translocation may lead to pancreatic infection and eventually a fulminant course. Therefore, it is important to prevent bacterial translocation. Patients with severe pancreatitis or paralytic ileus need to undergo insertion of a stomach tube or a long tube. Furthermore, continuous arterial infusion of protease inhibitors and antibiotics, selective digestive decontamination and enterol nutrition are available for treatment of bacterial translocation. |