- Ileus is a medical condition characterized by a functional obstruction of the intestines, meaning that the normal coordinated muscular contractions (peristalsis) of the bowel are reduced or absent.
- Unlike a mechanical obstruction, which occurs when something physically blocks the passage of intestinal contents, ileus is due to a disruption in the neuromuscular activity of the gastrointestinal tract. This results in the failure of intestinal contents, gas, and secretions to move forward, leading to distension, discomfort, and potential complications if left untreated.
- Ileus can affect any part of the gastrointestinal tract but is most commonly seen in the small intestine and colon.
- The causes of ileus are diverse.
- It often occurs after abdominal surgery, known as postoperative ileus, due to handling of the intestines, anesthesia, or the effect of opioid pain medications that suppress gut motility.
- Other common causes include severe systemic illnesses, electrolyte imbalances (such as low potassium), abdominal infections (like peritonitis or appendicitis), trauma, certain medications, and prolonged immobilization. Unlike mechanical bowel obstruction, there is no physical barrier; instead, the intestines become temporarily “paralyzed.”
- Clinically, patients with ileus often present with abdominal distension, bloating, crampy or diffuse abdominal pain, nausea, and vomiting. A hallmark feature is the absence or significant reduction of bowel sounds on examination, reflecting the lack of peristaltic activity. Patients may also be unable to pass stool or gas. On imaging, plain abdominal X-rays or CT scans typically reveal dilated loops of bowel with air-fluid levels and an absence of a clear transition point, which helps distinguish ileus from a mechanical obstruction.
- Management of ileus is largely supportive. The mainstays of treatment include bowel rest (nothing by mouth), intravenous fluid therapy to correct dehydration and electrolyte imbalances, and nasogastric tube decompression if vomiting and distension are severe. Underlying causes, such as infections or medication side effects, should be identified and corrected. Most cases resolve with conservative management, but prolonged or complicated cases may require further intervention. Preventive strategies in postoperative settings include minimizing opioid use, encouraging early mobilization, and using enhanced recovery protocols.
- While ileus is usually reversible, it can lead to complications such as bowel ischemia, perforation, or severe malnutrition if prolonged. Differentiating ileus from mechanical obstruction is critical, as the latter may require urgent surgical intervention. Therefore, timely diagnosis, supportive care, and monitoring are essential to ensure recovery and to prevent morbidity.
