One of the most frustrating problems in attempting to administer gastrointestinal nutrition in the patient with burns is paralytic ileus.

Definition:

The word Ileus is used to describe the loss of intestinal peristalsis or lack of effective coordinated peristalsis. A severe traumatic injury distant to the abdomen, such as a burn, may cause gastrointestinal ileus, though a more severe loss of peristalsis (either more likely to occur or longer time before normal peristalsis returns) may occur after direct injury to the peritoneal cavity due to trauma or surgery (2). The etiology of the peristaltic ileus is likely multifactorial, but alpha-adrenergic hyperactivity associated with stress has been implicated as an important mediator(1,3).

The various segments of the gastrointestinal tract are not equally susceptible to paralytic ileus. The small bowel appears to be relatively resistant to the development of traumatic ileus, and activity usually returns within the first few hours following the insult(6). However, colonic motility may not return for 24 hours after extra-adominal procedures and may require 72 hours or more after intra-abdominal manipulations(5). The return of gastric motility may take 24 to 96 hours(8).

References and additional information:

1. Catchpole, B. N.: Ileus: Use of sympathetic blocking agents in its treatment. Surgery, 66:811-820, 1969.

2. Kirksey, T.D. and Moncrief, J.S., Jr.: Gastrointestinal complications in burns. Am. J. Surg., 116:627-633, 1968.

3. Mishra, N. K., Appert, H. E., and Howard, J. M.: Studies of paralytic ileus. Effects of intraperitoneal injury on motility of the canine small intestine. Am. J. Surg., 129:559-563, 1975.

4. Molnar, J.A., Bell, S.J., Goodenough, R.D., and Burke, J.F. Enteral nutrition in patients with burns or trauma. In: Tombeau, J.L. and Caldwell, M.D., eds. Enteral and Tube Feeding Philadelphia, PA: W.B. Saunders; 1984: p. 422.

5. Rothnie, N. B., Harper, R. A. K., and Catchpole, B. N.: Early postoperative gastrointestinal activity. Lancet, 2(7298):64-67, 1963.

6. Wells, C., Rawlinson, K., Tinckler, L., Jones, H., and Saunders, J.: Ileus and postoperative intestinal motility: Preliminary communication. Lancet, 2:136-137, 1961.

7. Williamson, J. Physiologic stress: Trauma, sepsis, burns and surgery. In: Mahan, L. K. and Arlin, M, eds. Krause's Food, Nutrition and Diet Therapy. 8th edition. Philadelphia, PA: W.B. Saunders; 1992: p.500.

8. Woods, J. H., Erichkson, L. W., Condon, R. E., Schulte, W. J., and Sillin, L. F.L Postoperative ileus: A colonic problem? Surgery, 84:527-532, 1978.