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Íleo paralítico

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 20 Aug 2025
Last updated: 11 Oct 2023

Summary

Definition

Anamnesis y examen

Principales factores de diagnóstico

  • 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)
Todos los datos

Otros factores de diagnóstico

  • obstipação (constipação grave, sem passagem de fezes ou flatos)
  • desconforto e cólica abdominal
  • ruídos hidroaéreos reduzidos ou hipoativos
  • hipovolemia
Todos los datos

Factores de riesgo

  • 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)
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • eletrólitos séricos
  • magnésio sérico
  • Hemograma completo
  • tomografia computadorizada (TC) do abdome e da pelve (com contraste intravenoso e contraste oral hidrossolúvel)
Todos los datos

Pruebas diagnósticas que deben considerarse

  • testes séricos da função hepática
  • amilase sérica
  • lipase sérica
  • radiografias do intestino delgado
  • estudo de esvaziamento gástrico
Todos los datos

Algoritmo de tratamiento

Agudo

íleo paralítico pós-operatório

causa não cirúrgica

En curso

íleo paralítico que dure mais de 3 dias ou que prolongue a recuperação pós-operatória

Colaboradores

Autores

Steven D. Wexner, MD, PhD (Hon), FACS, FRCS (Eng), FRCS (Ed), FRCSI (Hon)
Steven D. Wexner

Director

Digestive Disease Center

Professor and Chair

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Divulgaciones

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.

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.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

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.
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