Ileus

Last reviewed: 21 Apr 2022
Last updated: 21 Dec 2021

Summary

Definition

History and exam

Key diagnostic factors

  • 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)
Full details

Other diagnostic factors

  • obstipation (absolute constipation)
  • discomfort and abdominal pain
  • decreased or hypoactive bowel sounds
  • hypovolaemia
Full details

Risk factors

  • 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)
Full details

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • serum magnesium
  • urea and creatinine
  • arterial blood gases
  • abdomen and pelvis CT scan (with intravenous contrast and oral water-soluble contrast)
Full details

Investigations to consider

  • serum LFTs
  • serum lipase or amylase
  • small bowel series with oral water-soluble contrast
  • gastric emptying study
Full details

Treatment algorithm

ACUTE

postoperative ileus

non-surgical cause

ONGOING

ileus lasting 4 days or longer post-surgery (prolonged ileus)

Contributors

Expert advisers

John Abercrombie, FRCS

General and Colorectal Surgeon

Queen's Medical Centre

Nottingham

UK

Biography

JA is Clinical Lead for General Surgery, Getting It Right First Time.

Disclosures

JA is a council member of the Royal College of Surgeons of England. He also provides expert advice to Spire Healthcare on clinical management of selected cases and on improving processes for review of cases resulting in mortality.

Acknowledgements

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

Peer reviewers

Michele Lucarotti, MD, FRCS

Consultant General & Colorectal Surgeon

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

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

Disclosures

SC declares that he has no competing interests.

Editors

Helena Delgado-Cohen,

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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