Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • nausea and vomiting
  • abdominal distention
  • no features of mechanical obstruction or peritoneal inflammation (e.g., abdominal hernia, peritoneal signs)

Other diagnostic factors

  • obstipation (severe constipation with no passage of stool or flatus)
  • discomfort and abdominal cramping
  • decreased or hypoactive bowel sounds
  • hypovolemia

Risk factors

  • abdominal surgery
  • nonabdominal surgery
  • acute/systemic illness (e.g., MI, pneumonia, acute cholecystitis, pancreatitis, sepsis, multiorgan trauma)
  • electrolyte imbalance
  • opioid analgesics, anticholinergics, or anesthetic gases
  • comorbidities (e.g., diabetes mellitus, cardiovascular insufficiency, Chagas disease, scleroderma)

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum magnesium
  • CBC
  • abdominal x-ray
Full details

Investigations to consider

  • serum LFTs
  • serum amylase
  • serum lipase
  • serum albumin and prealbumin
  • abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast)
  • small bowel series
  • gastric emptying study
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Steven D. Wexner

Director

Digestive Disease Center

Professor and Chair

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Disclosures

SDW has received consulting fees, stock options, and royalties from the following companies. These relationships are ongoing. Consulting - Axonics Medical, Intuitive Surgical, Karl Storz Endoscopy America, LifeBond, Medtronic, Novadaq, TiGenix. Stock options - Asana Medical, LifeBond, Pragma, Renew Medical. Royalties - Covidien, Intuitive Surgical, Karl Storz Endoscopy America, Unique Surgical Innovations. Inactive consulting agreements, but stock options retained for prior consulting - CRH Medical, Intuitive Surgical, Neatstitch, novoGI. There are no relevant disclosures to the submitted work.

Colorectal and Minimally Invasive Surgery

Division of General Surgery

Toronto Western Hospital

Assistant Professor

Department of Surgery

University of Toronto

Toronto

ON

Canada

Disclosures

ASC declares that he has no competing interests.

Dr Steven D. Wexner and Dr Ahmed Sami Chadi would like to gratefully acknowledge Dr Paula I. Denoya, a previous contributor to this monograph. PID declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Consultant Colorectal Surgeon

St. Mark's Hospital

Harrow

UK

Disclosures

JJ declares that he has no competing interests.

Use of this content is subject to our disclaimer