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Postoperative intestinal atony

definition

Postoperative bowel atony is a paralysis of the bowel that can occur after surgery.

Postoperative bowel atony is a paralysis of the bowel that occurs after an operation. In simplified terms, the intestine can be thought of as a muscle tube whose task, among other things, is to digest and transport the food ingested. The intestine has its own nervous system for this purpose, which stimulates the muscles in the intestine to tense. By regularly tensing and relaxing the muscles of the intestine, the food is always pushed a little further. In postoperative intestinal atony, the intestinal nervous system is temporarily dysregulated as a result of the operation and the intestinal muscles are paralyzed. This can lead to various symptoms such as stomach pain and nausea.

How long the bowel remains paralyzed depends on the type and duration of the operation. Which part of the intestine is affected also plays a role in the duration of the paralysis. For example, the Colon usually longer than a paralysis of the Small intestine. Postoperative intestinal atony does not only occur after operations on the intestine itself, but can also occur after operations on the kidneys, urinary bladder or on the sexual organs of men and women.

root cause

In postoperative intestinal atony, an operation that temporarily leads to a malfunction of the intestinal nervous system is the reason for the paralysis of the intestinal muscles. How exactly this malfunction of the intestinal nervous system occurs in postoperative intestinal atony has not yet been conclusively clarified. However, inflammation caused by certain cells in the intestine, direct mechanical irritation of the intestine and other factors are suspected. Other causes of paralysis of the intestinal muscles without prior surgery are, for example, circulatory disorders or congenital malformations of the intestine.

Symptoms

Typical complaints that occur in postoperative intestinal atony are constipation and even stool retention. This causes stomach pain, a bloated stomach, nausea, and possibly even vomiting. In addition, patients who suffer from postoperative intestinal atony have an increased risk of infections because the length of their stay in hospital is longer.

If the postoperative intestinal atony persists, complications can arise. One complication of postoperative intestinal atony is, for example, complete intestinal obstruction. The complete intestinal obstruction results in massive inflammation in the intestine with insufficient oxygen supply to the intestinal wall, which leads to severe stomach pain. If the intestinal wall perishes due to the lack of oxygen, it can lead to bleeding and blood in the stool. In the worst case, intestinal bacteria enter the abdominal cavity through the damaged intestinal wall, which leads to peritonitis, which is always life-threatening.

Read more on this topic at: These are the signs of a bowel obstruction

Diagnosis

Whether the patient has postoperative intestinal atony can usually be determined from a simple questioning of the patient. The diagnosis of postoperative intestinal atony is obvious if the patient has the typical symptoms after an operation, such as stomach pain, Stool retention and nausea indicates. The suspicion of postoperative intestinal atony can be confirmed by palpating and listening to the abdomen with the aid of a stethoscope. If the patient has postoperative intestinal atony, it is very likely that the patient will report pain when palpating. While listening, the doctor may notice that the typical noises that occur when the bowel is regularly tightened and relaxed are missing. Furthermore, postoperative intestinal atony can be avoided with X-ray overview image of the abdomen and one Ultrasound examination of the abdomen can be verified.

therapy

Various treatment measures can be considered in postoperative intestinal atony. The common goal of all these measures is to restore normal control of the intestinal muscles by the intestinal nervous system. Postoperative intestinal atony is usually treated conservatively. An important measure is the temporary abstinence from food, i.e. the complete waiver of food intake until the bowel function has normalized again. This is to prevent additional strain on the intestine and prevent vomiting. Once the activity of the intestine has normalized again, a careful diet can be started.

Enemas and warm, moist compresses, which are also used in postoperative intestinal atony, also stimulate the function of the intestine. Furthermore, drugs play a role in the treatment of postoperative intestinal atony. For example, drugs from the group of so-called parasympathomimetics are used. Parasympathomimetics stimulate the activity of the intestine. A representative of this group is the neostigmine. Other drugs are, for example, metoclopramide, a so-called dopamine receptor antagonist, which accelerates gastric emptying. Laxatives, so-called laxatives, are also used. Surgical treatment is usually not necessary. The complications of postoperative intestinal atony, such as complete intestinal obstruction or peritonitis, are emergencies that require immediate surgery.

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forecast

No further treatment is required once bowel function has returned to normal after postoperative bowel atony. Normal bowel function is usually completely restored after a few hours to several days.

prophylaxis

How to prevent the occurrence of postoperative intestinal atony is not yet fully understood. However, it is known that some factors have a positive effect on the course of intestinal paralysis. This includes, for example, the size of the wound caused by the operation. The smaller this is, the better the gradient. Furthermore, an early promotion of the patient's mobility, as well as an adequate one, have an effect Pain therapy immediately after the operation, also positive.