A slowing of gastrointestinal motility that is not associated with mechanical obstruction.
Most commonly presents following surgery and usually lasts 2 to 4 days.
Prolonged postoperative ileus contributes significantly to longer hospitalization and increased healthcare costs.
Treatment includes bowel rest, supportive care, and treatment of any underlying exacerbating factors.
Prevention requires a multimodal approach, including the substitution of postoperative opioid analgesia with nonsteroidal 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 (GI) 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 physiologic stress, including surgery, sepsis, metabolic derangements, and GI diseases.
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)
Other diagnostic factors
- obstipation (severe constipation with no passage of stool or flatus)
- discomfort and abdominal cramping
- decreased or hypoactive bowel sounds
- abdominal surgery
- nonabdominal surgery
- acute/systemic illness (e.g., myocardial infarction, pneumonia, acute cholecystitis, pancreatitis, sepsis, multiorgan trauma)
- electrolyte imbalance
- opioid analgesics, anticholinergics, or anesthetic gases
- comorbidities (e.g., diabetes mellitus, cardiovascular insufficiency, Chagas disease, scleroderma)
1st investigations to order
- serum electrolytes
- serum magnesium
- abdominal x-ray
Investigations to consider
- serum LFTs
- serum amylase
- serum lipase
- serum albumin and prealbumin
- abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast)
- small bowel series
- gastric emptying study
ileus lasting longer than 3 days or prolonging the postoperative recovery
Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCS (Ed), FRCSI (Hon)
Digestive Disease Center
Professor and Chair
Department of Colorectal Surgery
SDW has received consulting fees, stock options, and royalties from the following companies. These relationships are ongoing. Consulting - Intuitive Surgical, Karl Storz Endoscopy America, Medtronic, TiGenix. Royalties - Covidien, Intuitive Surgical, Karl Storz Endoscopy America, Unique Surgical Innovations. There are no relevant disclosures to the submitted work.
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.
SPS, ASC, and PID declare that they have no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
JJ declares that he has no competing interests.
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