Spinal ileus

Abstract

Spinal ileus is a functional intestinal obstruction complicating a lesion in the spine. In 8 cases reported here the primary pathology was a spinal fracture in 2 cases, a prolapsed intervertebral disk in 3 cases, and 1 case each of fractured pelvis, infarcted spinal cord, and plaster-cast treatment for a tuberculous cervical spine. The intestinal disturbance was a pseudo-obstruction in 5 cases and an adynamic ileus in 3, and involved small or large bowel. That an intestinal obstruction is of functional origin is suggested by the presence of a plausible remote cause—in these cases a spinal lesion, which was often painful. Colicky abdominal pain and loud bowel-sounds do not exclude the diagnosis; indeed they are the rule in pseudo-obstruction. A predominantly gaseous bowel distension seen on plain radiographs, together with the release of flatus by sigmoidoscopy if there is dilatation of the distal colon, further support the diagnosis, which may then be accepted provisionally provided there is no marked abdominal tenderness. Subsequently the absence of a mechanical obstruction may be proved by contrast radiography. Treatment generally follows accepted conservative lines with nasogastric and rectal intubation, and intravenous fluid replacement as necessary. However, operative treatment is indicated in a minority of patients if there develops serious doubt as to the diagnosis, or if gross distension threatens caecal rupture or respiratory failure.