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)
Other diagnostic factors
- obstipation (absolute constipation)
- discomfort and abdominal pain
- decreased or hypoactive bowel sounds
- hypovolaemia
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)
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)
Investigations to consider
- serum LFTs
- serum lipase or amylase
- small bowel series with oral water-soluble contrast
- gastric emptying study
Treatment algorithm
postoperative ileus
non-surgical cause
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.
Differentials
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie's syndrome)
- Gastroenteritis
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