Resumo
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- presence of risk factors
- nausea and vomiting
- abdominal distention or tenderness
- no features of mechanical obstruction or peritoneal inflammation (e.g., abdominal hernia, peritoneal signs)
Другие диагностические факторы
- obstipation (absolute constipation)
- discomfort and abdominal pain
- decreased or hypoactive bowel sounds
- hypovolaemia
Факторы риска
- abdominal surgery
- acute/systemic illness (e.g., myocardial infarction, pneumonia, acute cholecystitis, pancreatitis, sepsis, multi-organ trauma)
- non-abdominal surgery
- electrolyte imbalance
- opioid analgesics, anticholinergics, or anaesthetic gases
- comorbidities (e.g., diabetes mellitus, cardiovascular insufficiency, Chagas disease, scleroderma)
Диагностические исследования
Исследования, которые показаны в первую очередь
- FBC
- serum electrolytes
- serum magnesium
- urea and creatinine
- arterial blood gases
- abdomen and pelvis CT scan (with intravenous contrast and oral water-soluble contrast)
Исследования, проведение которых нужно рассмотреть
- serum LFTs
- serum lipase or amylase
- small bowel series with oral water-soluble contrast
- gastric emptying study
Алгоритм лечения
postoperative ileus
non-surgical cause
ileus lasting 4 days or longer post-surgery (prolonged ileus)
Составители
Эксперты-консультанты
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen's Medical Centre
Nottingham
UK
Раскрытие информации
JA is a member of the Council of The Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.
Выражение благодарностей
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Steven D. Wexner MD, PhD (Hon), FACS, FRCS, FRCS (Ed), FRCSI (Hon)
Director, Digestive Disease Center
Professor and Chair, Department of Colorectal Surgery
Cleveland Clinic
Weston
FL
Раскрытие информации
SDW has received consulting fees, stock options, and royalties from the following companies. These relationships are ongoing. Consulting - Intuitive Surgical, Karl Storz Endoscopy America, Medtronic, TiGenix. Royalties - Covidien, Intuitive Surgical, Karl Storz Endoscopy America, Unique Surgical Innovations. There are no relevant disclosures to the submitted work.
Рецензенты
Michele Lucarotti, MD, FRCS
Consultant General & Colorectal Surgeon
Gloucestershire Royal Hospital
Gloucester
UK
Раскрытие информации
ML declares that she has no competing interests.
Stephen Chapman, MBChB, BSc(Hons), MRCS(Eng)
NIHR Doctoral Research Fellow
General Surgery Registrar
Leeds Institute of Medical Research
University of Leeds
Leeds
UK
Раскрытие информации
SC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus - an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. Аннотация
Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg. 2019 Mar;43(3):659-95.Полный текст Аннотация
Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].Полный текст
Powell-Tuck J, Gosling P, Lobo DN, et al. British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP). March 2011 [internet publication].Полный текст
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie's syndrome)
- Gastroenteritis
Больше ОтличияРекомендации
- Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendation
- Commissioning guide: emergency general surgery (acute abdominal pain)
Больше РекомендацииVídeos
Nasogastric tube insertion animated demonstration
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