Ileus natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

If left untreated, patients with ileus may progress to develop abdominal pain, abdominal distention, nausea and vomiting with postprandial discomfort. Common complication of ileus include electrolyte imbalance, malabsorption, dehydration, intestinal perforation, ascites, sepsis, jaundice, and pulmonary complications. 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.

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 duration and cause of ileus (surgery or drugs), 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 motility, malabsorption 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
• Malabsorption
• 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.