[New findings in the differential diagnosis of acute ileus (author's transl)].

Knowledge of the patho-physiological behaviour present in the colon is the deciding factor for a reliable differential diagnosis of mechanical or paralytic ileus. A quick and sure diagnosis can be got with irrigoscopy (barium enema). In paralytic ileus, a radical change in the function of the right colon is present; instead of resorption, exudation and paralysis have taken place. Barium enema shows this behaviour; the left colon stays contracted, the contrast medium passes easily into the right colon, where it mixes with the fluid levels. This picture is proof of paralytic ileus. A completely different picture is to be found in mechanical ileus of the small intestine; the small intestine is gas-inflated, with fluid levels, and passes nothing on to the colon which, therefore, is contracted in its whole length. This picture also is diagnostic. Barium enema is already known in the diagnosis of mechanical ileus of the large intestine. It can also be used in the diagnosis of paralytic enterocolitis (without diarrhoea) in childhood and old age. In the case of post-operative early ileus it gives a quick and sure differential diagnosis.