Detailed Abstract
[E-poster - Biliary & Pancreas (Pancreas Disease/Surgery)]
[EP 176] Paralytic Ileus Among Patients with Acute Pancreatitis: A Prospective Study
Mukesh Kumar Ranjan, Pradeep Neupane, Sagar Poudyal, Bigyan Maharjan, Roshan Kumar Yadav, Mukesh Kumar Ranjan
Internal Medicine, Chitwan Medical College, Bharatpur, Nepal
Background : Paralytic ileus is a common complication of acute pancreatitis. Ileus affects feeding and oral administration of medications in addition to causing patient discomfort. However, there is sparse data regarding ileus and predictors of this common entity.
Methods : A prospective study conducted between September 2022 to January 2024 at Chitwan Medical College with aim to assess the prevalence and predictors of paralytic ileus. Ileus was defined as absence of bowel sounds with imaging suggestive of ileus without mechanical obstruction, and presence of at least two of the following symptoms: nausea/vomiting, abdominal distension, absence of flatus for > 24 hours, and intolerance to diet for > 24 hours.
Results : Among 111 patients [mean age 44.4±15.4 years, male:82(73.8%), moderately severe (MSAP) and severe pancreatitis (SAP): 69(62.2%)] enrolled in this study, 24(21.6%) developed ileus. Ileus was more common in patients with severe disease (MSAP and SAP) compared to mild disease [23(33.3%) vs 1(2.3%); (p<0.001)]. The factors significantly associated with ileus were acute necrotizing disease (p<0.001), hypertension (p=0.002), diabetes (p=0.022), hypothyroidism (p= 0.045) and alcohol-hypertriglyceridemia combined as etiology (p=0.043). Acute necrotic collection (p<0.001), splenic vein thrombosis (p= 0.008), pleural effusion (p<0.001), ascites (p<0.001) and urinary tract infection (p= 0.039) were significantly higher in patients with ileus. The total number of hospital days in patients with ileus was significantly higher compared to those without ileus (9.5±4.7 days vs 4.5±3.3 days; p<0.001). On multivariate analysis, hypothyroidism, splenic venous thrombosis, a high modified CT severity index, and high blood urea level were found to be predictive of Ileus development.
Conclusions : Paralytic ileus is common in moderately severe and severe acute pancreatitis compared to mild pancreatitis and leads to significant increase in hospital stay. The presence of splenic vein thrombosis, high urea level, hypothyroidism, and a high CT severity index predicts development of ileus.
Methods : A prospective study conducted between September 2022 to January 2024 at Chitwan Medical College with aim to assess the prevalence and predictors of paralytic ileus. Ileus was defined as absence of bowel sounds with imaging suggestive of ileus without mechanical obstruction, and presence of at least two of the following symptoms: nausea/vomiting, abdominal distension, absence of flatus for > 24 hours, and intolerance to diet for > 24 hours.
Results : Among 111 patients [mean age 44.4±15.4 years, male:82(73.8%), moderately severe (MSAP) and severe pancreatitis (SAP): 69(62.2%)] enrolled in this study, 24(21.6%) developed ileus. Ileus was more common in patients with severe disease (MSAP and SAP) compared to mild disease [23(33.3%) vs 1(2.3%); (p<0.001)]. The factors significantly associated with ileus were acute necrotizing disease (p<0.001), hypertension (p=0.002), diabetes (p=0.022), hypothyroidism (p= 0.045) and alcohol-hypertriglyceridemia combined as etiology (p=0.043). Acute necrotic collection (p<0.001), splenic vein thrombosis (p= 0.008), pleural effusion (p<0.001), ascites (p<0.001) and urinary tract infection (p= 0.039) were significantly higher in patients with ileus. The total number of hospital days in patients with ileus was significantly higher compared to those without ileus (9.5±4.7 days vs 4.5±3.3 days; p<0.001). On multivariate analysis, hypothyroidism, splenic venous thrombosis, a high modified CT severity index, and high blood urea level were found to be predictive of Ileus development.
Conclusions : Paralytic ileus is common in moderately severe and severe acute pancreatitis compared to mild pancreatitis and leads to significant increase in hospital stay. The presence of splenic vein thrombosis, high urea level, hypothyroidism, and a high CT severity index predicts development of ileus.
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E-Session 03/21 ALL DAY