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Ileus

(Paralytic Ileus; Adynamic Ileus; Paresis)

By

Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York

Last full review/revision Sep 2021| Content last modified Sep 2021
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Ileus is a temporary arrest of intestinal peristalsis. It occurs most commonly after abdominal surgery, particularly when the intestines have been manipulated. Symptoms are nausea, vomiting, and vague abdominal discomfort. Diagnosis is based on x-ray findings and clinical impression. Treatment is supportive, with nasogastric suction and IV fluids.

Etiology of Ileus

The most common cause of ileus is

  • Abdominal surgery

Other causes include

Gastric and colonic motility disturbances after abdominal surgery are common. The small bowel is typically least affected, with motility and absorption returning to normal within hours after surgery. Stomach emptying is usually impaired for about 24 hours or more. The colon is often most affected and may remain inactive for 48 to 72 hours or more.

Symptoms and Signs of Ileus

Symptoms and signs of ileus include abdominal distention, nausea, vomiting, and vague discomfort. Pain rarely has the classic colicky pattern present in mechanical bowel obstruction Intestinal Obstruction Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. Symptoms include... read more Intestinal Obstruction . There may be obstipation or passage of slight amounts of watery stool. Auscultation reveals a silent abdomen or minimal peristalsis. The abdomen is not tender unless the underlying cause is inflammatory.

Diagnosis of Ileus

  • Clinical evaluation

  • Sometimes x-rays

The most essential task is to distinguish ileus from intestinal obstruction Diagnosis Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. Symptoms include... read more Diagnosis . In both conditions, x-rays show gaseous distention of isolated segments of intestine. In postoperative ileus, however, gas may accumulate more in the colon than in the small bowel. Postoperative accumulation of gas in the small bowel often implies development of a complication (eg, obstruction Intestinal Obstruction Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. Symptoms include... read more Intestinal Obstruction , peritonitis Peritonitis Abdominal pain is common and often inconsequential. Acute and severe abdominal pain, however, is almost always a symptom of intra-abdominal disease. It may be the sole indicator of the need... read more ). In other types of ileus, x-ray findings are similar to obstruction; differentiation can be difficult unless clinical features clearly favor one or the other. A contrast-enhanced CT may help differentiate between the two and suggest an underlying cause of the ileus.

Treatment of Ileus

  • Nasogastric suction

  • IV fluids

Treatment of ileus involves continuous nasogastric suction, nothing by mouth, IV fluids and electrolytes, a minimal amount of sedatives, and avoidance of opioids and anticholinergic drugs. Maintaining an adequate serum potassium level (> 4 mEq/L [> 4.00 mmol/L]) is especially important. Ileus persisting > 1 week probably has a mechanical obstructive cause, and laparotomy should be considered.

Sometimes colonic ileus can be relieved by colonoscopic decompression; rarely, cecostomy is required. Colonoscopic decompression is helpful in treating pseudo-obstruction (Ogilvie syndrome), which consists of apparent obstruction at the splenic flexure, although no cause can be found by contrast enema or colonoscopy for the failure of gas and feces to pass this point. Some clinicians use IV neostigmine (which requires cardiac monitoring) to treat Ogilvie syndrome.

Key Points

  • There are many causes of ileus; abdominal surgery is the most common.

  • Auscultation reveals a silent abdomen or minimal peristalsis.

  • Distinguish ileus from intestinal obstruction.

  • Treat with nasogastric suction and IV fluids.

  • Avoid opioids and anticholinergic drugs.

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