Management

Management of paralytic ileus is summarised by the usual management phrase in obstruction: drip and suck, i.e.:

• nasogastric suction, used only if necessary, i.e. due to vomiting and gastric distention
• fluid requirements given intravenously
• patient kept nil by mouth; may be given small sips of water to drink or ice cubes to suck
• check for and correct any fluid/electrolyte disorder
• observe for signs of recovery from ileus
• further management depends on the cause of ileus: if the ileus persists for more than 4 days postoperatively then this suggests some other cause than just postoperative reflex paralytic ileus
• colonoscopy permits decompression of the gut while simultaneously conclusively establishing the diagnosis
• if there is caecal perforation or if the patient's general condition deteriorates then a caecostomy with the insertion of a wide-bore catheter is indicated