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
    • Opioid-induced
    • Post-operative (irritation +/- opioids)
    • Electrolyte imbalance (hypokalemia, hypomagnesemia)
    • Colonic pseudo-obstruction (aka Ogilvie's syndrome)
    • Gallstone ileus, pancreatitis
  • Peritonitis (e.g. from infection, malignancy, trauma)
  • Clostridium difficile colitis
    • Burns, acute radiation syndrome
    • Spastic ileus (rare: porphyria or lead poisoning)


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

  • Small bowel obstruction
  • See constipation, abdominal pain


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
    • Metoclopramide, erythromycin
  • Opioid antagonist: methylnaltrexone
  • Ogilvie's syndrome: Neostigmine 2mg IV


Disposition

See Also

  • Small bowel obstruction
  • Toxic megacolon


External Links

References

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