Ileus

• • Adynamic ileus is a functional obstruction due to dysmotility of the bowel

  • Distinguished from postoperative ileus following abdominal surgery (distinction is based on time since operation and clinical circumstances)

  • May present with signs and symptoms of bowel obstruction

  • Must differentiate ileus from mechanical bowel obstruction

  • Thought to occur as a result of dysfunction due to a combination of neural, hormonal, and metabolic factors

  • Occurs with intra-abdominal processes such as pancreatitis, abscess, hemorrhage, peritonitis

  • Sympathetic hyperactivity is thought to be a potential contributing factor

  • Diagnosis of exclusion

Epidemiology

• • Common following abdominal surgery, trauma

  • May be induced by medication:

  • -Narcotics

    -Psychotropic

    -Anticholinergics

  • May result from metabolic/electrolyte abnormalities such as hypokalemia and hypercalcemia or hypocalcemia and hypomagnesemia, uremia, diabetic ketoacidosis

Symptoms and Signs

• • Abdominal tenderness

  • Abdominal distention

  • Hypoactive to absent bowel sounds

  • Absence of flatus or passage of stool

Laboratory Findings

• • Nonspecific

  • May have electrolyte derangements (hypokalemia, hyponatremia)

Imaging Findings

• • Abdominal x-ray

  • -Dilated loops of bowel with air throughout the GI tract

    -No transition point suggesting mechanical obstruction

    -Air-fluid levels may or may not be present

• • Mechanical bowel obstruction (eg, neoplasm, hernia, adhesions)

Rule Out

• • Mechanical causes of bowel obstruction

• • History and physical exam

  • Digital rectal exam

  • History of trauma, recent surgery

  • Review medications

  • Draw serum chemistry, CBC, thyroid function tests

  • Must rule out mechanical obstruction

  • Diagnosis of exclusion

  • Obtain upright abdominal and chest films

  • Obtain contrast enema or CT scan to rule out mechanical etiology as well as evaluate for intra-abdominal pathology contributing to ileus

When to Admit

• • Ileus is a diagnosis of exclusion requiring mechanical sources to be ruled out as a cause of obstruction, which likely requires admission

  • Dehydration

• • Treatment is conservative

  • NPO

  • NG decompression

  • IV hydration

  • Correct electrolyte abnormalities

  • Discontinue or substitute for narcotic pain medications or psychotropic medications if possible

Surgery

Indications

• • Treatment of ileus is nonoperative

  • Conditions contributing to ileus such as abscesses or hemorrhage may require operative intervention

Medications

• • Prokinetic agents such as metoclopramide and erythromycin

Treatment Monitoring

• • Repeat physical exam

  • Failure of ileus to resolve after a prolonged period of time may warrant repeat GI contrast study and/or CT scan

Complications

• • Dehydration

  • Malnutrition

Prognosis

• • Time and correction of underlying contributing factors usually results in resolution of ileus