Incidence, Predictors, Management, and Outcome of Paralytic Ileus in Acute Pancreatitis.

BACKGROUND

Paralytic ileus is a frequent complication of acute pancreatitis (AP), contributing to increased morbidity, nutritional compromise, and risk of infection. Despite its clinical relevance, data on its incidence, predictors, management, and outcomes in AP remain limited.

METHODS

We conducted a retrospective study of 426 adult patients admitted with AP over a 3-year period at a tertiary-care center. The primary outcome was paralytic ileus; secondary outcomes included infected necrosis, intervention, and mortality. Multivariate logistic regression identified independent predictors expressed as adjusted odds ratio (aOR).

RESULTS

Paralytic ileus occurred in 167/426 (39.2%) patients. Patients with ileus were more frequently male, obese, and had higher rates of SIRS compared with those without ileus. They also exhibited significantly higher leukocyte counts, neutrophil-lymphocyte ratio (NLR), serum creatinine, and lower serum albumin and sodium levels. In multivariate analysis, obesity (aOR: 2.329), NLR (aOR: 1.131), serum albumin (aOR: 0.342), and serum sodium (aOR: 0.802) were identified as independent predictors. An NLR of 9.5 had a sensitivity of 82.6% and a specificity of 76.1% for predicting paralytic ileus. Conservative management resolved ileus in 85% of cases, 6% responded to neostigmine, while 9% with unresolved ileus succumbed to multiorgan failure. Paralytic ileus was independently associated with increased risk of infected necrosis (aOR: 3.62), intervention (aOR: 4.43), and mortality (aOR: 4.71).

CONCLUSION

Paralytic ileus affects a significant proportion of patients with moderate to severe AP and is a marker of local and systemic complications. Paralytic ileus was an independent predictor of infected necrosis, intervention, and mortality, underscoring its prognostic relevance.