Ans. a (No intestinal sounds heard). (Ref. Bailey & Love, 25th/1198)# Differentiation between persistent paralytic Ileus and early mechanical obstruction may be difficult in early postoperative period. Latter is probably more common.# Postoperative ileus is characterized by absent intestinal sounds.# Early evidence (days 1-5) is usually due to non-strangulating obstructive cause like fibrinous adhesions and edema.# Postoperative adynamic Ileus usually presents after a week of operation.Paralytic ileusThis may be defined as a state in which there is failure of trans- mission of peristaltic waves secondary to neuromuscular failure . The resultant stasis leads to accumulation of fluid and gas within the bowel, with associated distension, vomiting, absence of bowel sounds and absolute constipation.Varieties# Postoperative:a degree of ileus usually occurs after any abdominal procedure and is self-limiting, with a variable duration of 24-72 hours. Postoperative ileus may be prolonged in the presence of hypoproteinaemia or metabolic abnormality (see below).# Infection: intra-abdominal sepsis may give rise to localised or generalised ileus. Resultant adhesions may contribute a mechanical element to the initial neurogenic aetiology.# Reflex ileus: this may occur following fractures of the spine or ribs, retroperitoneal haemorrhage or even the application of a plaster jacket.# Metabolic: uraemia and hypokalemia are the most common contributory factors.Specific treatment is directed towards the cause, but the fol- lowing general principles apply:# The primary cause must be removed. * Gastrointestinal distension must be relieved by decompression.# Close attention to fluid and electrolyte balance is essential.# There is no place for the routine use of peristaltic stimulants.Rarely, in resistant cases, medical therapy with an adrenergic blocking agent in association with cholinergic stimulation, e.g. neostigmine (the Catchpole regimen), may be used, provided that an intraperitoneal cause has been excluded.# If paralytic ileus is prolonged and threatens life, a laparotomy should be considered to exclude a hidden cause and facilitate bowel decompression.