Uremic Paralytic Ileus in a 70 Years Old Female: A Diagnostic Dilemma

Uremia has been associated with slowed intestinal motility, resulting in loss of peristalsis and the development of paralytic ileus. We present a case of uremia-induced paralytic ileus in a 70-year-old woman. The patient was admitted with a 7-day history of abdominal pain, vomiting, and constipation. Initial evaluation revealed a soft non-tender abdomen with decreased bowel sounds. Urgent ultrasonography showed dilated gut loops and sluggish gut motility, while atrophic kidneys with hydronephrosis were also appreciated. Routine biochemistry labs revealed elevated creatinine and potassium levels, and an erect abdominal X-ray showed mild to moderate air-fluid levels. Notably, common risk factors for paralytic ileus, such as recent surgery or gastrointestinal procedures, immobility, hypokalemia, hypothyroidism, hypercalcaemia, hypocalcemia, hypomagnesemia, and diabetes mellitus, were ruled out. The patient also had no history of anticholinergic or opioid use. Given the absence of other causes, uremia was established as the underlying cause of paralytic ileus. After initial treatment for ileus, the patient underwent hemodialysis, which led to significant improvement in symptoms. This case highlights the importance of recognizing uremia as a potential cause of unexplained ileus, contributing to the limited literature on uremia-associated ileus.