Ileus – Bowel Obstruction: Causes, Symptoms, Treatment
Ileus is a bowel obstruction in which the passage of intestinal contents is completely or largely blocked. It is a medical emergency requiring immediate treatment.
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Ileus is a bowel obstruction in which the passage of intestinal contents is completely or largely blocked. It is a medical emergency requiring immediate treatment.
What is an Ileus?
An ileus refers to a complete or near-complete blockage of the intestinal passage, meaning that food, fluids, and gases can no longer move through the bowel. This condition constitutes a medical emergency and must be treated promptly, as it can become life-threatening if left unmanaged.
Types of Ileus
Mechanical Ileus
A mechanical ileus involves a physical obstruction within the intestine that prevents bowel contents from passing through. The blockage can arise from a variety of structural causes.
Paralytic Ileus (Functional Ileus)
A paralytic ileus involves no physical blockage. Instead, the muscles of the intestinal wall are paralyzed and unable to generate coordinated contractions (peristalsis) to propel contents forward.
Causes
Causes of Mechanical Ileus
- Adhesions: Scar tissue from previous abdominal surgery that compresses or kinks the bowel
- Hernias: Loops of bowel trapped in a hernia defect
- Tumors: Colorectal cancer or other growths that narrow the intestinal lumen
- Volvulus: Twisting of the bowel around its own axis
- Intussusception: Telescoping of one bowel segment into another (especially in children)
- Fecal impaction: Hardened stool blocking the bowel
- Foreign bodies: Swallowed objects lodged in the intestine
Causes of Paralytic Ileus
- Abdominal surgery (postoperative ileus)
- Peritonitis (inflammation of the abdominal lining)
- Severe electrolyte imbalances (e.g., low potassium)
- Medications (e.g., opioids, anticholinergics)
- Serious systemic illness such as sepsis or myocardial infarction
- Intestinal ischemia (poor blood supply to the bowel)
Symptoms
Symptoms of an ileus can vary depending on the type and severity, but typically include:
- Severe abdominal pain: Cramping and colicky pain in mechanical ileus; diffuse discomfort in paralytic ileus
- Nausea and vomiting: Initially gastric contents, later fecal-smelling vomitus in advanced cases
- Abdominal distension: Bloating due to accumulated gas
- Absence of bowel movements and flatulence
- Bowel sounds: Initially increased in mechanical ileus, later absent; absent from the outset in paralytic ileus
- General malaise, weakness, and circulatory instability
Diagnosis
The diagnosis of an ileus is established through a combination of examinations:
- Physical examination: Palpation and auscultation of the abdomen to assess bowel sounds
- Blood tests: Inflammatory markers, electrolytes, and kidney function
- Abdominal X-ray: Reveals air-fluid levels and dilated bowel loops
- Ultrasound: Assessment of bowel wall and peristaltic activity
- Computed tomography (CT) of the abdomen: Gold standard for precise localization and identification of the cause
- Contrast imaging: Used in selected cases to better visualize the site of obstruction
Treatment
General Measures
Regardless of the type of ileus, initial stabilizing measures are initiated promptly:
- Hospital admission and close monitoring
- Fasting (nothing by mouth)
- Insertion of a nasogastric tube to decompress the stomach and bowel
- Intravenous fluids and electrolyte replacement
- Pain management
Treatment of Mechanical Ileus
Mechanical ileus usually requires surgical intervention. Depending on the underlying cause, this may involve releasing adhesions, resecting a tumor, or correcting a volvulus. In selected cases, an endoscopic approach such as placement of a colonic stent may be sufficient.
Treatment of Paralytic Ileus
Paralytic ileus is primarily managed conservatively, with the goal of addressing the underlying cause and restoring intestinal function. This includes:
- Treatment of the underlying condition
- Discontinuation or adjustment of causative medications
- Correction of electrolyte imbalances
- Early mobilization after surgery
- Prokinetic agents to stimulate bowel motility in selected cases
Complications
If left untreated, an ileus can lead to serious complications, including:
- Intestinal necrosis: Death of bowel tissue due to loss of blood supply
- Bowel perforation: Rupture of the intestinal wall with spillage of contents into the abdominal cavity
- Peritonitis: Life-threatening inflammation of the peritoneum
- Sepsis: Systemic infection entering the bloodstream
- Shock and multi-organ failure
References
- Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Advances in Surgery, 2005. PubMed.
- Sajid MS et al. Systematic review of operative and non-operative management of acute adhesive small bowel obstruction. British Journal of Surgery, 2014.
- World Gastroenterology Organisation (WGO) – Practice Guidelines on Bowel Obstruction and Ileus, current edition.
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