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
Disclosures
JA is a member of the Council of The Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.
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
Disclosures
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.
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.
References
Key articles
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus - an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. Abstract
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.Full text Abstract
Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].Full text
Powell-Tuck J, Gosling P, Lobo DN, et al. British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP). March 2011 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie's syndrome)
- Gastroenteritis
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- Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendation
- Commissioning guide: emergency general surgery (acute abdominal pain)
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