Ileus

Ileus is a condition affecting the small bowel, where the normal peristalsis that pushes the contents along the length of the intestines, temporarily stops. It may be referred to as paralytic ileus or adynamic ileus. 

Pseudo-obstruction is a term used to describe a functional obstruction of the large bowel, where patients present with intestinal obstruction, but no mechanical cause is found. This is less common than ileus affecting the small bowel.

 

Causes

There is a long list of things that can make the bowel unhappy, leading to ileus. Common causes are:

  • Injury to the bowel
  • Handling of the bowel during surgery
  • Inflammation or infection in, or nearby, the bowel (e.g., peritonitis, appendicitis, pancreatitis or pneumonia)
  • Electrolyte imbalance (e.g., hypokalaemia or hyponatraemia)

 

The most common time you will see ileus is following abdominal surgery. This usually resolves with supportive care within a few days.

 

Signs and Symptoms

The signs and symptoms are akin to bowel obstruction, with:

  • Vomiting (particularly green bilious vomiting)
  • Abdominal distention 
  • Diffuse abdominal pain
  • Absolute constipation and lack of flatulence
  • Absent bowel sounds (as opposed to the “tinkling” bowel sounds of mechanical obstruction)

 

Management

The ileus will usually resolve with treatment of the underlying cause. Management involves supportive care.

Supportive care involves:

  • Nil by mouth or limited sips of water
  • NG tube if vomiting
  • IV fluids to prevent dehydration and correct the electrolyte imbalances
  • Mobilisation to helps stimulate peristalsis
  • Total parenteral nutrition (TPN) may be required whilst waiting for the bowel to regain function

 

Last updated May 2021
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