Ileus

What is an Ileus?

Ileus is a transient impairment of intestinal motility without a mechanical obstruction. This motility failure commonly occurs after abdominal surgery, but the incidence of prolonged postoperative ileus varies widely depending on the type of surgery and the definition used. Early recognition is important because prolonged ileus must be distinguished from mechanical bowel obstruction and other postoperative complications.

What causes an Ileus?

Ileus results from impaired gastrointestinal motility caused by factors such as postoperative neuroinflammatory changes, opioids, electrolyte abnormalities, intra-abdominal inflammation, and severe illness. The etiology of intestinal obstruction in an ileus is functional, with no physical blockage impeding intestinal flow, unlike a mechanical bowel obstruction. Intra-abdominal inflammation, sepsis, hemorrhage, or other complications can prolong ileus and should prompt reassessment.

What are the signs and symptoms of an Ileus?

Diffuse abdominal distension and tympany (a drum-like sound on percussion) characterize the clinical presentation because gas accumulates without forward motility. Physical examination typically reveals hypoactive or absent bowel sounds. Patients may have mild diffuse discomfort, whereas severe colicky pain is more suggestive of a mechanical obstruction. These features help practitioners differentiate ileus vs obstruction during a bedside evaluation. Nausea and vomiting frequently occur as proximal segments fail to propel contents forward.

How is an Ileus diagnosed?

Plain abdominal radiographs may show diffuse gaseous distension of the bowel with no clear transition point. If mechanical obstruction cannot be excluded clinically or radiographically, abdominal CT is typically obtained to evaluate for obstruction and other intra-abdominal complications. Laboratory evaluation often identifies hypokalemia or hypomagnesemia, electrolyte abnormalities that promote dysmotility. Serial abdominal examinations and monitoring of abdominal distension, oral intake, vomiting, and passage of flatus or stool help guide further evaluation.

How is an Ileus treated?

Standard ileus treatment is supportive and includes intravenous fluids, correction of electrolyte abnormalities, and treatment of reversible causes. Minimizing the use of narcotics reduces the pharmacological suppression of intestinal motility. Nasogastric decompression may be used selectively for persistent vomiting or marked distension, and bowel rest is typically used until symptoms improve. Early mobilization is recommended, and chewing gum may be used as an adjunct in postoperative ileus.

What are the most important facts to know about an Ileus?

• Ileus is a nonmechanical decrease in intestinal motility that commonly occurs after abdominal surgery, historically referred to as ileus paralysis.
• Common causes of ileus include postoperative inflammation, opioids, electrolyte abnormalities, infection, and severe systemic illness, all without a physical obstruction.
• Clinical findings such as distension and absent bowel sounds assist in the critical comparison of ileus vs obstruction.
• Imaging findings such as diffuse bowel gas without a clear transition point support the diagnosis and help exclude mechanical obstruction.
• Ileus treatment is supportive and includes correction of reversible causes, intravenous fluids and electrolyte repletion, selective decompression, opioid minimization, and early mobilization.