Summary
Definition
History and exam
Key diagnostic factors
- 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)
Other diagnostic factors
- obstipação (constipação grave, sem passagem de fezes ou flatos)
- desconforto e cólica abdominal
- ruídos hidroaéreos reduzidos ou hipoativos
- hipovolemia
Risk factors
- 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)
Diagnostic investigations
1st investigations to order
- eletrólitos séricos
- magnésio sérico
- Hemograma completo
- tomografia computadorizada (TC) do abdome e da pelve (com contraste intravenoso e contraste oral hidrossolúvel)
Investigations to consider
- testes séricos da função hepática
- amilase sérica
- lipase sérica
- radiografias do intestino delgado
- estudo de esvaziamento gástrico
Treatment algorithm
íleo paralítico pós-operatório
causa não cirúrgica
íleo paralítico que dure mais de 3 dias ou que prolongue a recuperação pós-operatória
Contributors
Authors
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
Disclosures
SHER declares that he has no competing interests.
Acknowledgements
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.
Disclosures
SPS, ASC, and PID declare that they have no competing interests.
Peer reviewers
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
DJH declares that he has no competing interests.
John Jenkins, MB CHB, FRCP
Consultant Colorectal Surgeon
St. Mark's Hospital
Harrow
UK
Disclosures
JJ declares that he has no competing interests.
References
Key articles
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus-an ongoing conundrum. Neurogastroenterol Motil. 2021 May;33(5):e14046. Abstract
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.Full text Abstract
American College of Radiology. ACR Appropriateness Criteria: suspected small-bowel obstruction. 2019 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Obstrução intestinal mecânica
- Pseudo-obstrução (síndrome de Ogilvie)
- Gastroenterite
More DifferentialsGuidelines
- ACR Appropriateness Criteria: suspected small-bowel obstruction
- Consensus statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery
More GuidelinesVideos
Demonstração animada da inserção de sonda nasogástrica
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer