Ileus overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Ileus is a disruption of the normal propulsive gastrointestinal motor activity from non-mechanical mechanisms.[1][2] Motility disorders that result from structural abnormalities are termed mechanical bowel obstruction. Some mechanical obstructions are misnomers, such as gallstone ileus and meconium ileus, and are not true examples of ileus by the classic definition. [3]
Historical Perspective
The word ileus has been derived from the Greek word "είλειν" which means to twist. In 1958, Robertson, Eddy, and Vosseler were the first to describe a case of adynamic ileus associated with cecal perforation.
Classification
There is no specific system for classification of postoperative ileus. However, based on etiology, postoperative ileus may be classified into drug induced ileus, metabolic and electrolyte abnormalities induced ileum, and systemic disorder induced ileus.
Pathophysiology
Causes
Ileus can be caused by both mechanical obstructions and non-mechanical obstructions.
Differentiating Ileus overview from Other Diseases
Ileus must be differentiated from other diseases that cause abdominal pain, constipation, nausea and vomiting such as small bowel obstruction, gastric outlet obstruction, gastroparesis, gastrointestinal perforation, acute cholecystitis, acute pancreatitis, chronic pancreatitis, liver abscess and spontaneous bacterial peritonitis.
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Nil per os (NPO or Nothing by Mouth) is mandatory in all cases. Nasogastric suction and parenteral feeds may be required until passage is restored. There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose, erythromycin or in severe cases, (Ogilvie's syndrome) neostigmine. If possible the underlying cause is corrected (e.g. replace electrolytes).
Surgery
Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms, or if there are signs of tissue death.
Prevention
Prevention depends on the cause. Treating conditions, such as tumors and hernias, that can lead to obstruction may reduce your risk of getting an obstruction. Some causes of obstruction cannot be prevented.
References
- ↑ Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. The biological basis of modern surgical practice. 17/e. Elsevier Saunders, 2004.
- ↑ Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci 1990;35:121.
- ↑ Feldman M, Friedman LS, Brandt LJ, Sleisenger MH. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Intestinal Obstruction and Ileus. 8/e. Elsevier Saunders, 2006.