Ileus

R. Brooke Jeffrey, MD

Key Facts

Imaging

Best diagnostic clue: Proportional dilatation of large and small intestine on plain films with no transition point
Best imaging tool: Plain abdominal radiography, NECT

Top Differential Diagnoses

Small or large bowel obstruction
Intestinal pseudo-obstruction
Ogilvie syndrome

Clinical Issues

Most common signs/symptoms
- Gaseous distension, abdominal pain, nausea and vomiting
Other signs/symptoms
- Constipation, bloating, lack of bowel sounds on auscultation
- Tympanic abdomen on percussion, lack of flatus
Postoperative ileus most common cause of delayed discharge from hospital
Postoperative ileus most often resolves spontaneously in 3-7 days
Treatment
- Treat underlying etiology (i.e., hypokalemia, sepsis)
- IV fluids
- Nasogastric suction

Diagnostic Checklist

Consider mechanical obstruction if transition zone seen on imaging

(Left) Supine abdominal radiograph in an 88-year-old man with abdominal distension and hypokalemia from diuretic use shows proportional dilation

of the large and small bowel with no clear transition point. The ileus resolved with electrolyte replacement. (Right) Supine radiograph in a 90-year-old woman with abdominal distension and pain following a hip “pinning” shows gaseous dilation of the colon