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Postoperative paralytic ileus prolongs hospitalization duration, increases medical expenses, and is even associated with postoperative mortality; however, effective prevention of postoperative paralytic ileus is not yet available. This trial aimed to assess the preventative effectiveness of transcutaneous electrical acupoint stimulation applied in the lower limbs on postoperative paralytic ileus incidence after colorectal surgery.After ethics approval and written informed consent, 610 patients from 10 hospitals who were scheduled for colorectal surgery between May 2018 and September 2019 were enrolled. Patients were randomly allocated into the transcutaneous electrical acupoint stimulation (stimulated on bilateral Zusanli, Shangjuxu, and Sanyinjiao acupoints in lower limbs for 30 minutes each time, total 4 times) or sham (without currents delivered) group with 1:1 ratio. The primary outcome was postoperative paralytic ileus incidence, defined as no flatus for72 hours after surgery.Compared to the sham treatment, transcutaneous electrical acupoint stimulation lowered the postoperative paralytic ileus incidence by 8.7% (32.3% vs 41.0%, P = .026) and decreased the risk of postoperative paralytic ileus by 32% (OR, 0.68; P = .029). Transcutaneous electrical acupoint stimulation also shortened the recovery time to flatus, defecation, normal diet, and bowel sounds. Transcutaneous electrical acupoint stimulation treatment significantly increased median serum acetylcholine by 55% (P = .007) and interleukin-10 by 88% (P.001), but decreased interleukin-6 by 47% (P.001) and inducible nitric oxide synthase by 42% (P = .002) at 72 hours postoperatively.Transcutaneous electrical acupoint stimulation attenuated the postoperative paralytic ileus incidence and enhanced gastrointestinal functional recovery, which may be associated with increasing parasympathetic nerve tone and its anti-inflammatory actions.

We report the clinical observation of a 46 years old woman developing Wernicke encephalopathy with an atypical presentation, which is complicated by severe dysautonomic syndrome with paralytic ileus, a rarely described complication. Moreover, the patient's Coca-Cola® addictive behaviour highlights the importance of considering the multifactorial origin of thiamine deficiency. Identifying the risk population and recognizing the symptoms in time is essential to avoid a diagnostic delay, potentially fatal, and can lead to a more efficient care management.

We report the case of a 62-year-old female who suffered from a persistent postoperative paralytic ileus following an urgent open cholecystectomy. On the fifth postoperative day we performed a bilateral Quadratus Lumborum Block (QLB) type 1 which resulted in a progressive resolution of the condition. This case report highlights that QLB is not only limited to somatic pain control, but it can also be used to alleviate visceral pain, namely in the context of paralytic ileus management in the postoperative period.

Background The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis.

The stage at which normal physiological postoperative ileus becomes the pathological entity known as paralytic ileus is ill-defined. This review looks at the common supportive treatments used in this situation and examines the evidence basis for their employment.

Postoperative ileus is considered an undesirable response to major abdominal surgery that leads to discomfort, complications, morbidity, and the prolongation of hospital stays. Although thoracic epidural analgesia has been introduced to prevent and/or reduce postoperative ileus, it is rarely used as a way to treat postoperative ileus. A 65-year-old man developed paralytic ileus after undergoing a colectomy. Despite conservative and surgical management, postoperative morbidity persisted. A continuous infusion of 0.2% levobupivacaine at a rate of 4 mL/hour was administered for 4 days via a thoracic epidural catheter that had been percutaneously tunneled into the T11–T12 epidural space. With this treatment, daily drainage from a nasogastric tube was gradually decreased and flatus was noted. A week later, the patient could start receiving a liquid diet. Therefore, thoracic epidural analgesia can be used to treat or alleviate paralytic ileus.

We report on a 30-year-old Dutch marine who was stationed in Eritrea and who was repatriated because of acute paralytic small-bowel ileus. The disease course was short and without signs of infection. After diagnostic work-up, we diagnosed Yersinia enterocolitica infection. To our knowledge this is the first reported case of Yersinia enterocolitica infection causing paralytic ileus in an adult.

Background: In a significant percentage of patients, radiologic evaluation other than plain abdominal films are required to confirm or exclude the presence of small bowel obstruction. Methods: Over a 1-year period, 55 patients had both computed tomography and small bowel follow-through studies. Patients were classified as having (1) paralytic ileus, (2) low-grade obstruction, (3) high-grade obstruction, or (4) complete mechanical obstruction. The gold standard for diagnosis was celiotomy in 42 patients and clinical follow-up in 13 patients. Results: Thirty-six out of 42 patients had proven intestinal obstruction at the time of celiotomy. Computed tomography identified 32 out of the 36 high-grade and complete mechanical obstructions. Computed tomography was superior to small bowel follow-through in identifying masses, malignancies, and features of strangulation. Small bowel follow-through correctly identified “insignificant obstructions” when contrast reached the cecum within 4 hours in 18 of 19 patients. Conclusions: In patients with equivocal findings of small bowel obstruction, computed tomography should be used initially and then small bowel follow-through if computed tomography is not diagnostic. Computed tomography was superior in this study for detecting the cause of the intestinal obstruction and presence of strangulation.

Five patients received overdoses of vincristine ranging from 3.5 to 32 mg. Neurotoxicity accounted for most of the complications observed. Peripheral neuropathies, cranial nerve palsies, paralytic ileus, atony of the bladder, hypertension, hypotension, seizures, inappropriate ADH secretion, and severe bone marrow depression were all encountered. Two patients died within 72 hours of the overdose. Another patient died of sepsis 22 days after the overdose. Two patients recovered and were discharged. The three patients who survived longer than a few days showed improvement in the vincristine-induced neuropathy, and the two long-term survivors had essentially complete recovery. It appears that if a patient can be supported through the critical period following an overdose, he can be expected to recover normal neurologic function.

1. 1. Vaginal hysterectomy is an operation which should be used more frequently than at present because the following can be accomplished at one time: complete removal of the uterus and cervix; cystocele, rectocele and enterocele repair; and if necessary the adnexae likewise can be removed. 2. 2. It is not recommended that vaginal hysterectomy completely replace the abdominal approach. There are definite occasions when the latter must be used. To indicate the attitude of the author, the following figures are presented. During the period covered by the survey 265 total and 347 subtotal hysterectomies were performed. In 461 of these cases some type of vaginal procedure was also performed at the time of the abdominal operation. The 129 vaginal hysterectomies reported herein and the number not surveyed were also performed during this same period. These figures are presented to indicate that the method is carefully chosen to suit the case. 3. 3. Vaginal hysterectomy with or without vaginal plastic is an operation practically free of thrombosis, embolism, abdominal peritonitis or paralytic ileus.

smoother. Its ad\ antages as a s:rf‘ct;.-valve and drain for the proximal intcstrne are obvious. T FIE experience of many lending surgeons during the last ten or twelve venrs has concurred in estabhshing . the YaIue of cnterostomy as a life-sax-ing prcxedure in se\.ere cases of acute peritonitis, acute intestina1 obstruction, paralytic ileus and intussusception and as an adclitionn1 step in association w,ith intestina resections. To the material aIreadp collected I should like to add my OWJ~ experience in support of the e\-idencc in justification of the operation of enterostom). under suitable incIic:ltions. To Victor Bonnet-’ belongs the chief crcclit for calling t*he attention of the professioil to jejunostomv as :I life-sa\-in:: measure in the treatment of acute intestinal obstruction and paral>,tic iIeus. He acl\,ocated this operation particularI>in the trcntmcnt of se-\,erely toxic cases, in which ;I more radical operation to relicvc the obstruction might pro1.e dangerous to Iil‘c. \l-ith respect to the indications for jejunostom?. and the results obtained, Bonrie~~ in 1916 \\-rote as follo\\3

Appendicitis remains a common surgical entity. The diagnosis is often unclear because of an atypical history and obscure physical findings. Four illustrative cases are presented. Awareness of atypical presentations of this disease, through both history and physical examination, will enhance diagnostic acumen. In doubtful cases a period of careful observation with serial evaluations of the patient will be necessary to arrive at a correct diagnosis. A high index of suspicion in cases of peritonitis and/or paralytic ileus of undetermined etiology should allow earlier diagnosis of this common and sometimes fatal illness. The difficulties posed in differentiating salpingitis and appendicitis are emphasized.

1. 1. The problem of acute intestinal obstruction of the small bowel resolves itself into a differentiation between (a) simple and strangulating types of obstruction and (b) acute obstructions of the large and small bowel. 2. 2. In any case of ileus an integration of the history, physical findings, laboratory data, especially x-ray films, must be made. 3. 3. Suction applied to an indwelling duodenal tube has a definite role in the treatment of acute intestinal obstruction. In acute mechanical and paralytic ileus complete relief of the obstruction may be obtained through this agent alone. In fact the lowest mortality yet reported for mechanical obstruction (6 per cent) has been with conservative therapy. Strangulating obstructions and acute complete obstructions of the colon should be treated by immediate operation. Siphonage drainage may be used as part of the treatment in these latter types of obstruction but its importance is secondary to operative treatment of the obstructed gut. If the indications and limitations of suction in the management of obstruction are kept in mind, there can be no doubt that a definite lowering of the mortality of acute intestinal obstruction is obtained by this method.

Since Schrader (1) began to synthesize alkyl-phosphates, a great many organo-phosphorus compounds have been produced. As these are cholinesterase inhibitors, some of them have been used as insecticides and the most toxic ones are regarded as potential war gases. A number of them have been put to use in medicine, e.g., di-tso-propoxy-phosphoryl fluoride (DFP) which was synthesized by Saunders (2). This compound has been used in the treatment of glaucoma, of post-operative paralytic ileus, and of myasthenia gravis.

Large bowel obstruction is still a serious disease with a high mortality rate. This is no doubt due to the fact that the condition is a disease of the aged, with the most common causes being carcinoma and diverticulitis; however, there are other unusual aspects which need attention. The occasional cases which are precipitated by paralytic ileus demonstrate an interesting obstructing mechanism. There may be bewildering diagnostic patterns, of which the most unusual are diarrhea and small bowel periumbilical or generalized crampy pain. This disease produces severe disturbed physiologic changes in the organism similar to small bowel obstruction, and the same preoperative fluid and antibiotic therapy is necessary.

1. 1. The diagnosis of paralytic ileus has been made in a series of cases by men who were aware of the writer's denial of the existence of that state in which peritonitis is or has been present. Photographs of the true disorder of these cases are presented. 2. 2. Where the diagnosis of adynamic ileus guides therapy, and the true disorder is mechanical, disaster follows.7 3. 3. The approach to this recommendation for a change in basic concept has been very slow. Preliminary papers on related subjects have been published,11 and corroboration from independent sources has been noted as necessary ground work for this recommendation.1–6,4 4. 4. Many years, many cases and a relatively few fruitful consultations and diagnoses of paralytic ileus have been carried to photographic conclusion as the basis for this argument against paralytic ileus as a complication of peritonitis after appendicitis; or in fact, after any acute peritonitis involving the small bowel. 5. 5. Proof of the mechanical nature of the ileus in each case is offered through photography, and convalescence after surgery for the correction thereof.

1. 1. A new method of treatment of intestinal obstruction is reported. 2. 2. The Miller-Abbott double lumen tube is described. 3. 3. The technique of insertion of the tube is outlined. 4. 4. The importance of placing the patient on his right side is emphasized. 5. 5. Every effort should be made to have the tube enter the duodenum without manipulation. 6. 6. If manipulation is necessary the fluoroscope is of aid. 7. 7. Cases illustrating the use of the tube in the treatment of paralytic ileus and mechanical obstruction are reported. 8. 8. The value of the tube in locating the site of a partial obstruction of the small intestine is demonstrated.

The data derived from 105 severe pelvic fractures have provided guidelines for managing paralytic ileus associated with fracture. Fracture types I, II, IV, and double type III can be treated expectantly with a high degree of confidence that ileus will resolve within 2 days. Type III diametric fractures can be managed similarly for 5 days with a 70 percent (14 of 20 patients in this study) likelihood that ileus will resolve. However, should ileus in patients with diametric fractures continue longer than 5 days, parenteral nutrition should be started, since ileus will persist for an average of 2 weeks. A direct correlation between type of pelvic fracture, amount of retroperitoneal blood, loss and duration of ileus has been documented.

Summary A case of mechanical small bowel obstruction caused by central dislocation of the hip is described. This complication is easily mistaken for the commoner paralytic ileus, and a method of differentiation is outlined.

SUMMARY Tetanus in a 52-year-old woman was managed by muscle paralysis and controlled pulmonary ventilation. Marked peripheral circulatory failure developed and was accompanied by a fall in temperature to subnormal levels (33.3°C) for five days. Paralytic ileus developed also. She was discharged three months after entering hospital.

A middle-aged Samoan man had an ependymoma of the fourth ventricle partially resected and afterwards treatment with radiotherapy and longterm Dexamethasone. Four months later he presented in a physically debilitated and mentally confused state and was found to have gram-negative septicemia. Terminally he developed melenous stools, a paralytic ileus and finally multiorgan failure. Postmortem the small and large bowel mucosa was congested, granular and friable with ‘tram track’ ulceration of the sigmoid colon.