Ileus natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Natural History

• If left untreated, patients with ileus may progress to develop abdominal pain, abdominal distention, nausea and vomiting with postprandial discomfort.
• Depending upon the underlying cause of ileus, these symptoms may range in severity from mild to severe.
• In postoperative ileus, some patients may have reversal of symptoms within 1-2 days of surgery.
• In patients where reversal of symptoms are not observed within 1-2 days of surgery, they may progress to develop more severe symptoms of ileus such as complete inhibition of intestinal transit, malabsorbtion with sepsis and intestinal perforation.
• Patients with sepsis and intestinal perforation require urgent medical attention and intervention. If untreated, severe ileus may be fatal.

Complications

Complications may include or may lead to:

• Electrolyte imbalance
• Malabsorbtion
• Dehydration
• Intestinal perforation
• Ascites
• Sepsis
• Jaundice
• Pulmonary complications

Prognosis

• Depending on the duration of the postoperative ileus at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
• Most cases of postoperative ileus resolve spontaneously and do not require any further treatment.
• In general, correction of electrolyte abnormalities and hydration leads to rapid reversal of symptoms associated with ileus.
• Prolonged postoperative ileus (> 7 days) requires close monitoring and evaluation for underlying mechanical obstruction.