小结
定义
病史和体格检查
关键诊断因素
- nausea and vomiting
- abdominal distention
- no features of mechanical obstruction or peritoneal inflammation (e.g., abdominal hernia, peritoneal signs)
其他诊断因素
- obstipation (severe constipation with no passage of stool or flatus)
- discomfort and abdominal cramping
- decreased or hypoactive bowel sounds
- hypovolemia
危险因素
- abdominal surgery
- acute/systemic illness (e.g., myocardial infarction, pneumonia, acute cholecystitis, pancreatitis, sepsis, multi-organ trauma)
- nonabdominal surgery
- electrolyte imbalance
- opioid analgesics, anticholinergics, or anesthetic gases
- comorbidities (e.g., diabetes mellitus, cardiovascular insufficiency, Chagas disease, scleroderma)
诊断性检查
首要检查
- serum electrolytes
- serum magnesium
- CBC
- abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast)
需考虑的检查
- serum LFTs
- serum amylase
- serum lipase
- small bowel series
- gastric emptying study
治疗流程
postoperative ileus
nonsurgical cause
ileus lasting longer than 3 days or prolonging the postoperative recovery
撰稿人
专家顾问
Steven D. Wexner, MD, PhD (Hon), FACS, FRCS (Eng), FRCS (Ed), FRCSI (Hon)
Director
Digestive Disease Center
Professor and Chair
Department of Colorectal Surgery
Cleveland Clinic
Weston, FL
利益声明
SDW has received consulting fees, stock options, and royalties from the following companies. These relationships are ongoing. Consulting: ICON Language Services, Intuitive Surgical, Stryker, Medtronic, Takeda, ARC/Corvus, Astellas, Baxter, Olympus, AIS Channel, Livsmed. Royalties: Medtronic, Intuitive Surgical, Karl Storz Endoscopy-America, Unique Surgical Innovations. Stock Options: Regentys, LifeBond, Pragma/GibLib, and Renew Medical.
Sameh Hany Emile Rizkalla, MBBCh, MSc, MD, FACS
Research associate, Colorectal Surgery Department
Digestive Disease Center
Professor and Chair
Department of Colorectal Surgery
Cleveland Clinic
Weston, FL
利益声明
SHER declares that he has no competing interests.
鸣谢
Dr Steven D. Wexner would like to gratefully acknowledge the contribution of Dr Stephen P. Sharp to the update for this topic. Dr Wexner would also like to acknowledge Dr Ahmed Sami Chadi, and Dr Paula I. Denoya, previous contributors to this topic.
利益声明
SPS, ASC, and PID declare that they have no competing interests.
同行评议者
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA
利益声明
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
Harrow
UK
利益声明
JJ 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.
参考文献
关键文献
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus- an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. 摘要
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.全文 摘要
American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie syndrome)
- Gastroenteritis
更多 鉴别诊断指南
- ACR appropriateness criteria: suspected small-bowel obstruction
- Guidelines for perioperative care in elective colorectal surgery
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