Acute ileus

Insertion of self-expanding metallic stents is now a well-established method to treat obstructions of the biliary tract (Rossi et al. 1994) and the oesophagus (Song et al. 1994 Adam et al. 1997). Recently their use has been extended to gastroduodenal outlet obstruction and treatment of acute ileus in colorectal obstruction. Patients with malignant gastroduodenal as well as colorectal obstruction are often elderly,... 

Fig. 3.9a-c. A 60-year-old patient with acute ileus due to carcinoma of the proximal descending colon, a There is insufficient spontaneous expansion of the 16-mm Wallstent. b Dilation with a 12-mm balloon, c There is adequate expansion of the stent after balloon dilation... 

In the two review articles by Mauro et al. (2000) and Zollikofer et al (2001) compiling series with more than ten patients between 1996 and 2000 with a total of 117 and 140 patients, respectively, undergoing preoperative stent placement for acute ileus, a clinical success was achieved in 89%-96%. The technical success rate for crossing the lesion with a guidewire and successive stent placement was 90% and 89%, respectively. The majority were treated with Wallstents (mainly of the oesophageal, vascular or Enteral ... 

Fulminant colitis Acute abdomen and systemic symptoms such as fever, tachycardia, dehydration, and hypotension. Some patients have marked leukocytosis (up to 40,000 white blood cells/mm3). Diarrhea is usually prominent but may not occur in patients with paralytic ileus and toxic megacolon. 

Oral/Suppositories - Use on as-needed basis respiratory depression acute or severe bronchial asthma paralytic ileus obstetrical analgesia (8 mg tablets, oral solution, and suppositories only) intracranial lesion associated with increased intracranial pressure (2 and 4 mg tablets only). 

IR concentrated oral solution and tablets/suppositories - Respiratory insufficiency or depression severe CNS depression attack of bronchial asthma heart failure secondary to chronic lung disease cardiac arrhythmias increased intracranial or CSF pressure head injuries brain tumor acute alcoholism delirium tremens convulsive disorders after biliary tract surgery suspected surgical abdomen surgical anastomosis concomitantly with MAOIs or within 14 days of such treatment paralytic ileus. 

DepoDur- Respiratory depression acute or severe bronchial asthma upper airway obstruction paralytic ileus head injury increased intracranial pressure circulatory shock. 

CR/IR tablets (15 and 30 mg)/IR capsules (5 mg)/ER/Concentrated solution -Significant respiratory depression acute or severe bronchial asthma hypercarbia paralytic ileus. 

Oxymorphone Hypersensitivity to morphine analogs acute asthma attack severe respiratory depression or upper airway obstruction paralytic ileus pulmonary edema secondary to a chemical respiratory irritant. 

Acute abdominal conditions Narcotics may obscure diagnosis or clinical course. Do not give SR morphine to patients with Gl obstruction, particularly paralytic ileus, as there is a risk of the product remaining in the stomach for an extended period and the subsequent release of a bolus of morphine when normal gut motility is restored. Special risk patients Exercise caution in elderly and debilitated patients and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Also exercise caution in patients sensitive to CNS depressants, including those with cardiovascular disease myxedema convulsive disorders increased ocular pressure acute alcoholism delirium tremens cerebral arteriosclerosis ulcerative... 

The most disturbing adverse reaction to clofazimine is a red-brown discoloration of the skin, especially in light-skinned persons. A rare but serious adverse reaction is acute abdominal pain significant enough to warrant exploratory laparotomy or laparoscopy. Other infrequent side effects include splenic infarction, bowel obstruction, paralytic ileus, and upper GI bleeding. 

Contraindications Bladder neck obstruction due to prostatic hypertrophy, cardiospasm, intestinal atony, myasthenia gravis in those not treated with neostigmine, narrow-angle glaucoma, obstructive disease of the GI tract, paralytic ileus, severe ulcerative colitis, tachycardia secondary to cardiac insufficiency or thyrotoxicosis, toxic megacolon, unstable cardiovascular status in acute hemorrhage... 

Contraindications Glaucoma, obstructive uropathy, obstructive disease of Gl-anti-cholinergic tract, paralytic ileus, intestinal atony of the elderly or debilitated patient, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis especially if complicated by toxic megacolon, myasthenia gravis, hiatal hernia associated with reflux esophagitis, hypersensitivity to any component of f he formulaf ion, acuf e infermiffenf porphyria. 

I Contraindications Acute hemorrhage, myasthenia gravis, narrow-angle glaucoma, obstructive uropathy paralytic ileus, tachycardia, ulcerative colitis... 

Contraindications Acute or severe asthma, GI obstruction, paralytic ileus, severe hepatic or renal impairment, severe respiratory depression... 

Contraindications Paralytic ileus, acute asthma attack, pulmonary edema secondary to chemical respiratory irritant, severe respiratory depression, upper airway obstruction... 

Prior to inclusion of hemosorption in therapy, all patients were in a poor condition due to severe endogenous intoxication and circulatory injury. 376 patients had a stable blood circulation and 64 had a reduced circulation of the blood. All patients had dynamic ileus, and 88 patients had acute multiple organ failure. A special feature of biochemical alterations was imbalance of the protease-inhibitor system. It was manifested in a significant elevation of TLA in blood plasma (P< 0.001) and decrease of a -PI and a -M concentrations (P< 0.001). The decrease of total protein and albumin, and the increase of urea and MM levels (P<0.001) were also characteristic for protein metabolism injury. 

Rhabdomyolysis, acute renal insufficiency, pancreatitis, ileus, livedo reticularis, and raised transaminase activities developed in a patient who had taken lovastatin for 7 years and took erythromycin before a dental procedure. 

Codeine and morphine are contraindicated in acute respiratory depression, acute alcoholism and where there is a risk of paralytic ileus. They should also be avoided in patients with raised intracranial pressure or head injury and in comatose patients. 

An 80-year-old woman taking lithium developed constipation, nausea, vomiting, and abdominal pain after starting to take amfebutamone. A diagnosis of acute paralytic ileus was made and attributed to amfebutamone, although an amfebutamone-lithium interaction could not be excluded (355). 

Acute extrapyramidal reactions occur more often after ingestion of high-potency drugs, such as haloperidol and fluphenazine these respond to parenteral benzatropine, but anticholinergic drugs should be used judiciously, so as not to worsen peripheral or central autonomic toxicity. Other serious, but less frequent, complications include paralytic ileus and hypothermia. Acute renal insufficiency has been very rarely reported, but is apparently reversible and can occur secondary to severe hypotension or other causes after acute ingestion (615). 

INDIRECT ANTIPSYCHOTICS 1. Case reports of paralytic ileus with trifluoperazine and methylphenidate 2. Case report of acute dystonias with haloperidol and dexamfetamine 3.1 efficacy of chlorpromazine when dexamfetamine was added 1. Additive anticholinergic effect 2. Uncertain possibly due to t dopamine release 3. Uncertain 1. Watch for signs of altered bowel habit 2. Warn patients of this rare interaction 3. Avoid co-administration... 

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