Ileus (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maheep Singh Sangha, M.B.B.S.
Overview
Ileus is temporary absence of intestinal movements leading to decreased movement of food contents. Ileus occurs in the absence of intestinal obstruction and is most commonly seen in postoperative conditions.
What are the symptoms?
- Abdominal swelling (distention)
- Abdominal fullness, gas
- Abdominal pain and cramping
- Breath odor
- Constipation
- Inability to pass gas
- Vomiting
What are the causes?
Ileus may due to:
Paralytic ileus, also called pseudo-obstruction, is one of the major causes in infants and children. Causes of paralytic ileus may include:
- Bacteria or viruses that cause intestinal infections (gastroenteritis)
- Chemical, electrolyte, or mineral imbalances (such as decreased potassium levels)
- Complications of abdominal surgery
- Decreased blood supply to the intestines (mesenteric ischemia)
- Infections inside the abdomen, such as appendicitis
- Kidney or lung disease
- Use of certain medications, especially narcotics
Diagnosis
During a physical exam, the health care provider may find bloating, tenderness, or hernias in the abdomen.
Tests that show obstruction include:
- Abdominal CT scan
- Abdominal x-ray
- Barium enema
- Upper GI and small bowel series
When to seek urgent medical care?
Call your health care provider if you:
- Cannot pass stool or gas
- Have a swollen abdomen (distention) that does not go away
- Keep vomiting
Treatment options
Treatment involves placing a tube through the nose into the stomach or intestine to help relieve abdominal swelling (distention) and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum.
Surgery may be needed incase the symptoms do not resolve over the course of days with treatment to relieve the obstruction if the tube does not relieve the symptoms, or if there are signs of tissue death.
Medications to avoid
Patients diagnosed with paralytic ileus should avoid using the following medications:
- Hyoscyamine
- Oxycodone
- Polyethylene glycol-electrolyte solution (PEG-ES)
If you have been diagnosed with paralytic ileus, consult your physician before starting or stopping any of these medications.
Prevention
Prevention depends on the cause. Treating conditions, such as electrolyte abnormalities, thyroid disorders, and diabete, that can predispose to ileus may reduce your risk.
What to expect (Outlook/Prognosis)?
The outcome depends on the cause of the ileus. Most of the time the cause is easily treated.
Possible complications
Complications may include or may lead to:
- Electrolyte (blood chemical and mineral) imbalances
- Dehydration
- Hole (perforation) in the intestine
- Infection
- Jaundice (yellowing of the skin and eyes)
When ileus persists for more than 7 days the cause is usually intestinal obstruction. The obstruction blocks the blood supply to the intestine, it may cause infection and tissue death (gangrene). Risks for tissue death are related to the cause of the blockage and how long it has been present. Hernias, volvulus, and intussusception carry a higher gangrene risk.
In a newborn, paralytic ileus that destroys the bowel wall (necrotizing enterocolitis) is life-threatening and may lead to blood and lung infections.