Ileus

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Last reviewed: 23 Sep 2025
Last updated: 18 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • nausea and vomiting
  • abdominal distention
  • no features of mechanical obstruction or peritoneal inflammation (e.g., abdominal hernia, peritoneal signs)
Full details

Other diagnostic factors

  • obstipation (severe constipation with no passage of stool or flatus)
  • discomfort and abdominal cramping
  • decreased or hypoactive bowel sounds
  • hypovolemia
Full details

Risk factors

  • 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)
Full details

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum magnesium
  • CBC
  • abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast)
Full details

Investigations to consider

  • serum LFTs
  • serum amylase
  • serum lipase
  • small bowel series
  • gastric emptying study
Full details

Treatment algorithm

ACUTE

postoperative ileus

nonsurgical cause

ONGOING

ileus lasting longer than 3 days or prolonging the postoperative recovery

Contributors

Expert advisers

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

Disclosures

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

Declarações

SHER declares that he has no competing interests.

Agradecimentos

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.

Declarações

SPS, ASC, and PID declare that they have no competing interests.

Revisores

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Declarações

DJH declares that he has no competing interests.

John Jenkins, MB CHB, FRCP

Consultant Colorectal Surgeon

St. Mark's Hospital

Harrow

UK

Declarações

JJ declares that he has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus- an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. Resumo

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.Texto completo  Resumo

American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Ileus images
  • Differentials

    • Mechanical bowel obstruction
    • Pseudo-obstruction (Ogilvie syndrome)
    • Gastroenteritis
    Mais Diagnósticos diferenciais
  • Guidelines

    • ACR appropriateness criteria: suspected small-bowel obstruction
    • Guidelines for perioperative care in elective colorectal surgery
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