Aktueller Stand zur Diagnostik und nichtoperativen Therapie des Dünndarmileus

Abstract

In obstructed small bowel the number of stercoral bacteria increases due to stasis, inducing a liberation of mediators that are leading to ileus disease with facultative sepsis and breakdown of the circulatory system. The therapeutic procedures have to cure the stasis. In the case of mechanical obstruction cure is achieved by operation, while functional ileus may be healed by conservative treatment. Implantation of a gastric tube or Dennis' tube can evacuate the small intestine. Several peristalsis-inducing drugs are in use, although their clinical relevance remaines to be demonstrated. Clinical examination and anamnesis offer initial information; X-ray of the abdomen confirms the diagnosis of ileus and is the baseline examination. Addition of oral contrast medium, ultrasonography, CT and endoscopy may help to evaluate the underlying cause of small-bowel paralysis.