Ileus
Резюме
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- nausea and vomiting
- abdominal distention
- no features of mechanical obstruction or peritoneal inflammation (e.g., abdominal hernia, peritoneal signs)
Другие диагностические факторы
- obstipation (severe constipation with no passage of stool or flatus)
- discomfort and abdominal cramping
- decreased or hypoactive bowel sounds
- hypovolemia
Факторы риска
- 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)
Диагностические исследования
Исследования, которые показаны в первую очередь
- serum electrolytes
- serum magnesium
- CBC
- abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast)
Исследования, проведение которых нужно рассмотреть
- serum LFTs
- serum amylase
- serum lipase
- small bowel series
- gastric emptying study
Алгоритм лечения
postoperative ileus
nonsurgical cause
ileus lasting longer than 3 days or prolonging the postoperative recovery
Составители
Эксперты-консультанты
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
Раскрытие информации
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
Раскрытие информации
SHER declares that he has no competing interests.
Выражение благодарностей
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.
Раскрытие информации
SPS, ASC, and PID declare that they have no competing interests.
Рецензенты
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Раскрытие информации
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
Harrow
UK
Раскрытие информации
JJ declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus- an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. Аннотация
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.Полный текст Аннотация
American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].Полный текст
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie syndrome)
- Gastroenteritis
Больше ОтличияGuidelines
- ACR appropriateness criteria: suspected small-bowel obstruction
- Guidelines for perioperative care in elective colorectal surgery
Больше GuidelinesVideos
Nasogastric tube insertion animated demonstration
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer