Occlusion or paralysis of the bowel preventing the forward passage of the intestinal contents, causing their accumulation proximal to the site of the blockage.
Mechanical obstruction of the gastrointestinal tract.
External compression (adhesions, hernia)
Changes in the bowel wall (tumour, inflammation/infection)
Blockage of the lumen (coprostasis, intussusception).
Postoperative ileus (POI):
Temporary cessation of coordinated bowel peristalsis after surgery, restricting the passage of bowel contents and rendering the patient unable to tolerate the oral intake of liquids or solid food.
Failure of normal intestinal motility in the absence of mechanical obstruction.
Reflectory ileus—after abdominal or retroperitoneal surgery (e.g., spinal surgery), or induced by intra-abdominal or retroperitoneal lesions (tumor, hemorrhage, infection)
Drug-induced ileus—due to the consumption of opioids, neuroleptic drugs, etc.
Metabolic ileus—in patients with hypokalemia or diabetes mellitus
Vascular ileus—due to hypoperfusion of the bowel.
- Adhesive disease (60%)
- Neoplasm (20%)
- Herniation (10%)
- Inflammatory bowel disease (IBD) (5%)
- Intussusception (< 5%)
- Volvulus (< 5%)
- Other (< 5 %)
Presents acutely with severe symptoms.
- Persistent and copious vomiting
- Modest abdominal pain
- Minimal abdominal distention
Presents with mild symptoms (volvulus of sudden onset is an exception).
- Significant abdominal distention and pain
- Malodorous vomiting (uncommon)
- Spontaneous perforation (3%)
Abdominal CT (GOLD STANDARD):
- Ascites: Acute liver failure, history of hepatitis or alcoholism
- Medications (e.g., tricyclic antidepressants, narcotics)
- Mesenteric ischemia: History of peripheral vascular disease, hypercoagulable state, or postprandial abdominal angina; recent use of vasopressors
- Perforated viscus/intra-abdominal sepsis: Fever, leukocytosis, acute abdomen, free air on imaging
- Postoperative paralytic ileus (POI): Recent abdominal surgery with no postoperative flatus or bowel movement
- Pseudo-obstruction (Ogilvie syndrome): Acutely dilated large intestine, history of intestinal dysmotility, diabetes mellitus, scleroderma
Conservative management (80%):
- Nasogastric feeding:
- IV fluid resuscitation (isotonic fluid)
- Aggressive replacement of electrolytes
- Antibiotics (treat intestinal overgrowth of bacteria and translocation across the bowel)
- Strangulation, ischemia, complete absence of transit of bowel contents
- Acute abdomen
- Failure of medical management
Postoperative ileus (POI) prophylaxis:
- Minimally invasive surgery
- Thoracic epidural catheter
- Postoperative gum-chewing