Ileus is a temporary stop in the normal movement of the bowel without any physical blockage. It is common after abdominal surgery and is also caused by opioids, low potassium, infection and inflammation inside the abdomen.
Key symptoms
- Bloating and a swollen belly
- Nausea and vomiting
- No passage of gas or stool
- Diffuse, mild crampy discomfort
What you find on exam
- Distended abdomen that sounds hollow on tapping
- Quiet or absent bowel sounds
- Mild diffuse tenderness without peritoneal signs
- Signs of dehydration; review recent surgery and medicines
Tests
- Abdominal X-ray: dilated small and large bowel with gas all the way to the rectum
- CT abdomen if obstruction or a leak is suspected
- Electrolytes (potassium, magnesium, calcium) and kidney function
- Blood count and lactate if infection or ischemia is a concern
Treatment basics
- Nothing by mouth at first, with IV fluids
- Nasogastric tube for vomiting or major distension
- Correct potassium and magnesium
- Reduce opioids; use other pain control and early walking
- Alvimopan in selected patients after bowel surgery
Red flags
- Fever, high heart rate or rising lactate
- Focal tenderness, guarding or a rigid belly
- Severe distension or no improvement after several days
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.