Organ last to recover in paralytic ileus is
|D||Rectum and anal canal|
a. Postoperative ileus affects the stomach and colon primarily.
b. After laparotomy, small bowel motility returns within several hours, gastric motility within 24 to 48 hours, and colonic motility in 48 to 72 hours.
d. Return of bowel activity is heralded by the presence of bowel sounds, flatus, and bowel movements.
e. Patients with early postoperative small bowel obstruction either do not show manifestations of bowel activity or have temporary return of bowel function. In adynamic ileus, the stomach, small bowel, and colon are affected.
f. In mechanical obstruction, the obstruction may be partial or complete, may occur in the proximal part of the small bowel (high obstruction) or in the distal part of the small bowel (low obstruction), and may be a closed-loop or open-ended obstruction.
g. There is stasis and progressive accumulation of gastric and intestinal secretions and gas, and the bowel may lose its tone and dilate, thereby resulting in abdominal distention, pain, nausea and vomiting, and obstipation.
h. Patients with high mechanical small bowel obstruction vomit early in the course and usually have no or minimal distention.
i. The vomitus is generally bilious. Patients with distal obstruction, on the other hand, vomit later in the course and have more pronounced abdominal distention.
j. The vomitus may initially be bilious then becomes more feculent.
k. With adynamic ileus patients have diffuse discomfort but no sharp colicky pain and a distended abdomen.