Last reviewed: May 2019
Last updated: March  2019

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
Full details

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
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Steven D. Wexner

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.

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.

Peer reviewers VIEW ALL

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Consultant Colorectal Surgeon

St. Mark's Hospital

Harrow

UK

Disclosures

JJ declares that he has no competing interests.

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