Резюме
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- presença de fatores de risco
- náuseas e vômitos
- distensão abdominal
- ausência de características de obstrução mecânica ou de inflamação peritoneal (por exemplo, hérnia abdominal, sinais peritoneais)
Другие диагностические факторы
- obstipação (constipação grave, sem passagem de fezes ou flatos)
- desconforto e cólica abdominal
- ruídos hidroaéreos reduzidos ou hipoativos
- hipovolemia
Факторы риска
- cirurgia abdominal
- doença aguda/sistêmica (por exemplo, infarto do miocárdio [IAM], pneumonia, colecistite aguda, pancreatite, sepse, trauma de múltiplos órgãos)
- cirurgia não abdominal
- desequilíbrio eletrolítico
- analgésicos opioides, anticolinérgicos ou gases anestésicos
- comorbidades (por exemplo, diabetes mellitus, insuficiência cardiovascular, doença de Chagas, esclerodermia)
Диагностические исследования
Исследования, которые показаны в первую очередь
- eletrólitos séricos
- magnésio sérico
- Hemograma completo
- tomografia computadorizada (TC) do abdome e da pelve (com contraste intravenoso e contraste oral hidrossolúvel)
Исследования, проведение которых нужно рассмотреть
- testes séricos da função hepática
- amilase sérica
- lipase sérica
- radiografias do intestino delgado
- estudo de esvaziamento gástrico
Алгоритм лечения
íleo paralítico pós-operatório
causa não cirúrgica
íleo paralítico que dure mais de 3 dias ou que prolongue a recuperação pós-operatória
Составители
Авторы
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
- Obstrução intestinal mecânica
- Pseudo-obstrução (síndrome de Ogilvie)
- Gastroenterite
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- ACR Appropriateness Criteria: suspected small-bowel obstruction
- Consensus statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery
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