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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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