1. Ileus István PULAY M.D. Semmelweis University, Faculty of Medicine, 1 st Department of Surgery

2. Ileus Obstruction of the gastrointestinal tract –Simple mechanic ileus –Ileus with strangulation

3. Symptoms Pain Obstipation Vomiting Abdominal dystension

4. Pysical findings Dryness of tongue Decrease of skin turgor Loss of water and electrolytes due to vomitus and fluid sequestration Hypotension, tachycardia High pitched metallic bowel sounds

5. Different symptoms of simple mechanic and strangulating ileus Colic pain Slow onset Metabolic alkalosis Steady pain Sudden onset Peritoneal irritation Body temperature >38C o Metabolic acidosis Tachycardia

6. Diagnostic tools Physical findings Laboratory findings X-ray studies –Plain abdominal, CT

7. Differential diagnosis Pancreatitis Appendicitis Renal colic Biliary colic Gastroenteritis Torsion eof ovarial cyst Diabetes mellitus Acute porphyria Tabes dorsalis

8. Therapy Naso-gastric tube Adequat fluid supply Antibiotic Acid-base therapy Operative treatment

9. Operative procedures Simple release of the obstruction By-pass of obstructive mass Resection of diseased part of intestine Enterostomy proximally to the point of obstruction (Hartmann procedure)

10. Relative frequency of origin of ileus Adhaesions Malignant tumor Hernia Inflammatory diseases of bowels Feces impactation Volvulus Gallstone All other

11. The causes of adynamic ileus Peritonitis Operative manipulation After simple obstruction Vascular insuffitiency Hirschprung disease Narcotics Retroperitoneal hematoma Spinal cord injury Pneumonia Hypokalemia Diabetes, porphyria