??? (Ileus)

1
??? (Ileus)

• ??? ??
• ???? ?????

2
???,81???

• ?????,??????
• ???? A ?? 3?
• ????
• T/P/R 36.9/84/14 BP 121/54
• ?? ??,?3?

3
???,81???

• ????
• ?94/06/10?????????????
• ??????
• ????
• Abdomen
• Soft but distended
• Bowel sound hypoactive
• No palpable mass
• No tenderness
• Tympanic percussion

4
???? Impression

• ???
• (Ileus)

5
????

• Fleet enema ? NPO IV Fluid ? (Lab) Primperan
  1amp. st q8h NG decom.
• Fleet enema KUB
• On Anal tube / Consult GS / Sign ?op
• Fever ? B/C 2 , Cefazolin GM
• CXR , EKG , U/A , Admit to GI ward

6
Clinical course

• 92-11-30 ER, ABD fullness for 3-4 days, Imp
  paralytic ileus, CT colon dilation, Scopy
  external compression at splenic flexture
• 92-12-0117 Admission.
• 94-02-10 ER , ABD fullness for 3 days
• 94-02-1019 Admission, suggest op.
• 94-06-09 ER, CT , GI LGI series but no volvulus,
  then MBD on 06-10

7
???

• ?? ???????????????
• ??
• Adynamic ileus (paralytic)
• Mechanical ileus
• ????

?? ??
Adhesion Carcinoma
Hernia Fecal Impaction
Intussusception Volvulus
8
????

• ?
• intermittent / crampy or constant
• ?
• bilious or feculent
• PE
• ?? / ?? / ??
• ? / ? / ? / ? / ? / ? / ?
• ???
• ?? / ?????? / SIRS / ??? / ???

9
????

• X ray
• KUB Standing Abdomen or Lat. decubitus
• ?free air / mass / ?? SBO or LBO
• Lab.
• CBC/DC , Electrolytes , BUN/Cr
• ? ?????? / ?????? / ??
• Others
• CT scan (??) / Sigmoidoscopy
• Barium enema / GI Series

10
????

• Mechanical Ileus
• Surgical intervention
• NG decompression
• Bowel evacuation Fleet enema / S-S enema
• Rectal tube / Sigmoidoscopy
• IV fluid / Antibiotics
• Adynamic Ileus
• Conservative treatment
• IV fluid / NG decompression / enema / antibiotics
• Prokinetic agent (Primperan)
• Avoid buscopan

11
Malrotation
Corkscrew appearance
"hurricane" or swirl appearance
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Volvulus
13
SMA occlusion
14
Inverted U-shaped or Coffee-bean sign
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Take Home Message

• Mechanical ilues ??????
• Adynamic ileus ??????
• ??????
• IV hydration / bowel evacuation / antibiotics
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