Ileus is a slowing of gastrointestinal motility that is not associated with mechanical obstruction.
Most commonly presents 2 to 3 days following surgery.
Prolonged postoperative ileus (lasting 4 days or longer post-surgery) contributes significantly to longer hospitalisation.
Treatment includes slow resumption of oral diet, supportive care, and treatment of any underlying exacerbating factors.
Prevention requires a multi-modal approach, including the substitution of postoperative opioid analgesia with non-steroidal anti-inflammatory drugs and thoracic epidural analgesia, early enteral feeding, early ambulation, and the use of laparoscopy rather than laparotomy whenever possible.
Ileus is a slowing of gastrointestinal motility accompanied by distention, in the absence of a mechanical intestinal obstruction. It is a diagnosis of exclusion after bowel obstruction has been ruled out. It usually occurs in response to physiological stress, including surgery (usually gastrointestinal), sepsis, metabolic derangements, and gastrointestinal diseases.
This topic covers the diagnosis and management of ileus in adults.
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)
Other diagnostic factors
- obstipation (absolute constipation)
- discomfort and abdominal pain
- decreased or hypoactive bowel sounds
- 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)
1st investigations to order
- serum electrolytes
- serum magnesium
- urea and creatinine
- arterial blood gases
- abdomen and pelvis CT scan (with intravenous contrast and oral water-soluble contrast)
Investigations to consider
- serum LFTs
- serum lipase or amylase
- small bowel series with oral water-soluble contrast
- gastric emptying study
ileus lasting 4 days or longer post-surgery (prolonged ileus)
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen's Medical Centre
JA is Clinical Lead for General Surgery, Getting It Right First Time.
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.
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
Michele Lucarotti, MD, FRCS
Consultant General & Colorectal Surgeon
Gloucestershire Royal Hospital
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
SC declares that he has no competing interests.
Section Editor, BMJ Best Practice
HDC declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
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