ICU · GI & nutrition / surgical

Ileus, Bowel Obstruction & Mesenteric Ischaemia — The Acute Abdomen in ICU

Also known as Paralytic ileus · Ileus · Small bowel obstruction · SBO · Large bowel obstruction · LBO · Bowel obstruction · Strangulation · Mesenteric ischaemia · SMA embolism · Non-occlusive mesenteric ischaemia · NOMI · Pain out of proportion

The ileus, the bowel obstruction, and the mesenteric ischaemia are the three acute bowel disorders in the ICU. The ileus (paralytic) is the failure of the peristalsis (the post-op, the opioid, the electrolyte, the sepsis) — the supportive management (the NGT, the fluids, the correct the electrolytes). The bowel obstruction (mechanical) is the SBO (the adhesions the commonest) or the LBO (the malignancy, the volvulus) — the drip and suck, the surgery for the strangulation (the continuous pain, the fever, the peritonitis, the raised lactate). The mesenteric ischaemia is the vascular compromise of the bowel — the SMA embolism (the AF), the thrombosis, the venous, the non-occlusive (the low-flow). The hallmark is the PAIN OUT OF PROPORTION to the exam; the lactate rises late; the CT angiography is the diagnostic; the early surgery (the high mortality from the delay).