Clinical problems in the management of ileus of the large intestine

Summary

Large-intestinal ileus remains a major challenge in diagnosis and management. A small personal series of 14 cases seen in recent years has been used to illustrate some of the problems. It is noted that primary neuromuscular disorders can be indistinguishable from organic obstruction. The secondary paralytic forms of ileus may have a complex origin, and often more than one etiologic factor is involved. Ischemic disease may cause ileus of the large bowel in subtle forms. Microscopic examination of the stool in these cases may reveal useful information. Iatrogenic factors will probably continue to plague us. The clinician should always remember to question the patient about the drugs he is taking. If operation is indicated, cecostomy seems safest and may control an otherwisedangerous state of distention. The success of cecostomy depends upon well-informed nursing management.