Ileus

Background

  • Failure or insufficiency in the peristalsis movement of the gastrointestinal tract which normally moves GI contents from mouth to anus.
  • Thought to be caused by a disruption in either the neural and/or neuro-hormonal reflexes that normally regulate bowel motility.
  • Multiple causes possible - likely an inflammatory condition
  • Peritonitis (e.g. from infection, malignancy, trauma)
  • Clostridium difficile colitis

Clinical Features

  • Abdominal pain/distension
  • Nausea/vomiting, inability to tolerate PO/enteral feeding
  • Constipation
  • Absent or hypoactive bowel sounds
  • Can produce intestinal ischemia, intestinal perforation, abdominal compartment syndrome

Differential Diagnosis

Evaluation

  • BMP, Mg
  • Abdominal x-ray: air fluid levels, air in bowel, distended bowel
  • Evaluate for underlying causes
  • If concern for SBO, CT abdomen

Management

  • Treat underlying causes
  • Avoid excessive IV fluids (bowel edema worsens ileus)
  • Avoid opioids
  • Pro-motility agents
  • Opioid antagonist: methylnaltrexone
  • Ogilvie's: Neostigmine 2mg IV

Disposition

See Also


External Links

References