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)
Other diagnostic factors
- obstipation (severe constipation with no passage of stool or flatus)
- discomfort and abdominal cramping
- decreased or hypoactive bowel sounds
- hypovolemia
Risk factors
- 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)
Diagnostic investigations
1st investigations to order
- serum electrolytes
- serum magnesium
- CBC
- 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
Treatment algorithm
postoperative ileus
nonsurgical cause
ileus lasting longer than 3 days or prolonging the postoperative recovery
Contributors
Authors
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.
Acknowledgements
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.
Disclosures
SPS, ASC, and PID declare that they have no competing interests.
Peer reviewers
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
Harrow
UK
Disclosures
JJ declares that he has no competing interests.
Differentials
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie syndrome)
- Gastroenteritis
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