Ileus

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(Adynamic Ileus; Paralytic Ileus; Nonmechanical Bowel Obstruction; Ogilvie’s Syndrome; Colonic Pseudo-obstruction)

Definition

Ileus is a type of bowel obstruction. It results when peristalsis stops. Peristalsis is the wavelike contractions that help push stool through the colon and small bowel.
Ileus is a “nonmechanical” bowel obstruction. The other type of obstruction is called a “mechanical” obstruction . Mechanical obstruction occurs when there is a physical blockage of the intestine.
Small Bowel Distention
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Causes

Ileus may be caused by:
  • Abdominal surgery
  • Joint or spine surgery
  • Injury or trauma
  • Infections, such as:
  • Heart attack
  • Imbalance of electrolytes
  • Disorders that affect muscle function
  • Use of certain drugs, such as narcotic pain drugs or high blood pressure medicine
  • Low blood supply to parts of intestine (mesenteric ischemia)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for ileus include:
  • Abdominal surgery, infection, or injury
  • Joint or spine surgery
  • A previous history of ileus
  • Use of certain pain or high blood pressure drugs
  • Certain health conditions or diseases, such as:
    • Lower lobe pneumonia
    • Heart attack

Symptoms

Symptoms of ileus may include:
  • Abdominal distention
  • Pain
  • Vomiting
  • Cramps
  • Hiccups
  • Inability to pass stool or gas

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam. Diagnosis of ileus is usually based on symptoms and testing. Tests may include:
  • X-rays —a test that uses radiation to take a picture of structures inside the body
  • CT scan —a test that uses radiation to take multiple pictures of the inside of your body
  • Barium enema —a test that uses radiation to take a picture of the colon, after the colon has been filled with barium
  • Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon

Treatment

If ileus was caused by surgery, it will usually resolve within 48 to 72 hours. In other cases, the disease that caused the ileus needs to be treated. This may involve adjusting the dose of a medication or replacing electrolytes.
Other treatments may be used to help ease symptoms. These may include:

Diet Limitation

Patients who suffer from ileus should not be fed until the ileus has resolved.

Nasogastric Suction (NG Tube)

A tube is inserted through the nose and into the stomach to remove digestive fluids. This will help relieve pain and bloating.

Intravenous Fluids and Electrolytes

Fluids are given by vein to avoid dehydration. Electrolytes are given by vein to help the ileus resolve.

Medications

There are medications that increase peristalsis (ie, neostigmine, tegaserod) that can be used in selected patients to help ileus resolve.

Colonoscopic Decompression

A flexible tube may be inserted into the colon to relieve pressure.

Surgery

Rarely, surgery is required to remove the part of the bowels affected.

Prevention

Since ileus is generally the result of injury, surgery, or a medical condition, there is little that can be done to prevent it.

RESOURCES

The American College of Gastroenterology http://www.acg.gi.org

American Gastroenterological Association http://www.gastro.org

International Foundation for Functional Gastrointestinal Disorders http://www.iffgd.org

CANADIAN RESOURCES

Canadian Digestive Health Foundation http://www.cdhf.ca/index.html

The Canadian Association of Gastroenterology (CAG) http://www.cag-acg.org/

References

Harrison’s Principles of Internal Medicine . 14th ed. McGraw-Hill; 1998.

Textbook of Gastroenterology . 4th ed. Lippincott Williams & Wilkins; 2003.

Revision Information

  • Reviewer: Daus Mahnke, MD
  • Review Date: 09/2012 -
  • Update Date: 00/91/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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