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. It is one of two types of bowel obstruction. The other type is called a “mechanical” obstruction. Mechanical obstruction occurs when there is a physical blockage of the intestine.

Causes

Ileus may be caused by:

• Abdominal surgery

• Injury or trauma

• Infections, such as:

• • Abdominal infections: peritonitis, appendicitis, diverticulitis

• • Pneumonia

• • Severe generalized infections (sepsis)

• 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

• 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-ray–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 48-72 hours. In other cases, the primary 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:

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

References:

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

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