[Paralytic and postoperative ileus (author's transl)].

Paralytic ileus is always a reaction of the organism to a disturbance usually due to metabolism. A treatment without elimination of the eliciting cause seems, therefore, to have little point. The efficacy of many substances given to stimulate peristalsis has not been proved. Drawing off the contents of the stomach and controlled infusion therapy, on the other hand, are important parts of the treatment, as for mechanical ileus. For the surgical emptying of the intestine, the most suitable procedure is retrograde squeezing of the intestinal contents to the stomach and aspiration through a nasal sound. Enterotomies should be avoided if at all possible. Surgical intervention for paralytic ileus is most frequently necessary in the postoperative phase, usually caused by a peritonitis with or without anastomotic failure. Differentiation from mechanical obstruction is not always possible. In the Erlangen Hospital, 233 patients were treated for postoperative ileus from 1965 to 1974. All patients with a mechanical ileus were operated on, the mortality was 17%. Of 123 patients with a paralytic ileus, 82 were operated on and 45 died. The mortality was almost equally high in patients not operated on.