Paralytic Ileus In Post CABG Patient; Always A Late Diagnosis

Consoling always does not work. A common problem after cardiac surgery- “not passing stool and feeling uncomfortable.” It makes us irritable and annoying. Then and there we turn our head or start consoling the patient, “Everything will be ok, don’t worry.”

Fig: Abdominal X Ray AP Erect view. Gaseous distention of the bowel loops seen succinctly.

In my case it was no different. I have been told by my consultant to check for the post operative CABG patient, who have complaint of uneasiness, an hour ago, during our morning round.

I was really hesitant to do that but I had to report to him. Anyway, i reached upto the patient and queried, “Are you ok?”

“I am not good doctor” the patient turned toward me and waited for my sympathy to do something.

“Don’t worry, everything will be ok.” I forced again.

“Something wrong with me” the patient replied with utmost respect.

Sympathized patients makes us more sympathised. I realised, something actually wrong, I need to find out.

“You have pain?” I asked. ” Yes, in the chest.” he replied.

He was on dual pain killers tablets and on fentanyl patch. I was forced to do a ECG.  No change came without the previous old changes.

“Sister, Is the patient mobilised today” I was asking the sister.

The patient replied, “No sir, I am feeling so weak and lethargic, not able to take even a single step.”

“Have you passed motion and flatus.”  I asked and looked for an answer.

Before the patient say “No” I reached for his abdomen and asked “Are you feeling uncomfortable with your belly.”

“Yes, since today morning”

I looked forward to check for his bowel sound. Big fatty belly and you don’t know where to put the stethoscope. Could not hear it. Tried again… could not hear it… waited for more a minute with my best ears on.

Ordered a proctoclysis enema and came back in 15 minutes. No change. Patient was getting more uncomfortable. No motion passed, no flatus yet and distention- you never measure how much with a big belly.

We usually don’t do abdominal X ray. In my 4 years in Cardiac surgery, I have not seen any patient having bowel issue 5 days after surgery, as this one. I met my consultant to do abdominal X ray. He hesitated first and insisted everything will be alright.

Anaesthesist’s advice was to go for an abdominal X ray and everything was clear in the film-gaseous distention of small intestine mostly paralytic ileus. Patient was kept NPO, started on IV fluids and was alright overnight.

Patient is always an open book. You need to read it.

Author: what2talk

Myself, Dr. Sibashankar Kar, doing my Cardiothoracic Surgery in Sir Ganga Ram Hospital. The purpose I have made this website is to discuss on the topics of cardiology and cardiac surgery as a whole with their complexities.

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