Which is worse, having a chronic paralytic ileus or getting 75 x-rays of your bowel? I'm not sure, but that's what this patient has endured over a fifteen month span. According to the reader who submitted this x-ray, this person has received seventy five abdominal x-rays in just over a year. That's five x-rays a month, every month, for 15 months. In addition, this patient has had eight CT scans of his abdomen and pelvis to evaluate the ileus since he moved to town from the West Coast. How much radiation is in 8 CT scans of the abdomen? If my memory serves me right, that is the equivalent of at least 2000-3000 flat plate x-ray films.
How many admissions has he had for paralytic ileus and or bowel obstruction and or partial bowel obstruction? That would be 26 admissions in 15 months? That's incredible. Twenty six admissions for ileus and every one of them is like Groundhog Day: Nasogastric decompression, fluids and time. Here is a view of that man's of chronic ileus.
I think the obvious needs stated at this point: Medical management of his paralytic ileus has been a complete failure. You can't get admitted to the hospital 26 times for anything and call it quality or successful. So what should we to do about a man like this with a chronic paralysis of his gut? I've seen plenty of folks like this myself. Great internists must, of course, exclude such nefarious diagnoses as a jelly fish bite and or a giant mesenteric lipoma. After that differential diagnosis has been ruled, out, we just have to suck it up as doctors and nurses and take care of the man for the rest of his life, or until he moves to another city. There ain't nothing we can do to make it go away! Although I'm pretty confident radiating him with more abdominal x-rays or CT scans isn't going to help.