Adynamic ileus, its pathogenesis and treatment

The article presents a rational treatment for adynamic ileus, based on an analysis of the physiological mechanisms underlying its occurrence. Adynamic ileus occurs following irritation within the abdominal cavity or following trauma or infection which may be intraabdominal or extraabdominal. The inhibition of gastrointestinal motility is due to increased activity in adrenergic nerves mediated through spinal or peripheral reflex pathways. The adrenergic nerves ramify in the enteric plexuses and act there to antagonize the transmission of excitation from intrinsic nerves to intestinal muscle. The receptors for noradrenaline within the plexuses are of the alpha type. Therefore adynamic ileus can be countered by drugs which antagonize the release of noradrenaline from the inhibitory adrenergic nerves (e.g. guanethidine, bretylium) or by drugs which block the action of noradrenaline at alpha receptors (e.g. phentolamine). Details of successful clinical experiences with this approach to the treatment of adynamic ileus are given.