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
- 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)
Diagnostic tests
1st tests to order
- serum electrolytes
- serum magnesium
- CBC
- abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast)
Tests to consider
- serum LFTs
- serum amylase
- serum lipase
- small bowel series
- gastric emptying study
Treatment algorithm
postoperative ileus
nonsurgical cause
ileus lasting longer than 3 days or prolonging the postoperative recovery
Contributors
Expert advisers
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
Disclosures
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
Divulgaciones
SHER declares that he has no competing interests.
Agradecimientos
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.
Divulgaciones
SPS, ASC, and PID declare that they have no competing interests.
Revisores por pares
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh, PA
Divulgaciones
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
Harrow
UK
Divulgaciones
JJ declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus- an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. Resumen
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.Texto completo Resumen
American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Mechanical bowel obstruction
- Pseudo-obstruction (Ogilvie syndrome)
- Gastroenteritis
Más DiferencialesGuías de práctica clínica
- ACR appropriateness criteria: suspected small-bowel obstruction
- Guidelines for perioperative care in elective colorectal surgery
Más Guías de práctica clínicaVideos
Nasogastric tube insertion animated demonstration
Más vídeos
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad