Ileus Workup

  • Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC; Chief Editor: Julian Katz, MD   more...
 
Updated: Apr 8, 2011
 

Laboratory Studies

  • Laboratory studies and blood work should focus on evaluations for infectious, electrolytic, and metabolic derangements.
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Imaging Studies

  • On plain abdominal radiographs, ileus appears as copious gas dilatation of the small intestine and colon. With enteroclysis, the contrast medium in patients with paralytic ileus should reach the cecum within 4 hours; if the contrast medium remains stationary for longer than 4 hours, mechanical obstruction is suggested.[15]
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Contributor Information and Disclosures
Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC  Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Coauthor(s)

Ese Otah, MD, FACS  Consulting Surgeon, Center For General and Laparoscopic Surgery, PA; Consulting Staff, St Luke's Sugar Land Hospital, Memorial Hermann Southwest Hospital, Memorial Hermann Sugar Land Hospital

Ese Otah, MD, FACS is a member of the following medical societies: American College of Surgeons and Association of Women Surgeons

Disclosure: Nothing to disclose.

Kenneth E Otah, MD, MSc, FACC  Consulting Staff, Methodist and Memorial Hermann Hospital Systems, Total Heart Cardiovascular Consultants, LLC

Kenneth E Otah, MD, MSc, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians, and Association of Black Cardiologists

Disclosure: Nothing to disclose.

Oluwagbenga Serrano, MD  Consulting Staff, Lake Havasu Gastroenterology, PC

Disclosure: Nothing to disclose.

John A Walker, MD  Consulting Staff, Gastroenterology Consultants PC; Consulting Staff, Department of Gastroenterology, Rogue Valley Medical Center, Providence-Medford Medical Center, Surgery Center of Southern Oregon and Ashland Community Hospital

John A Walker, MD is a member of the following medical societies: American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Avram M Cooperman, MD  Professor of Surgery and Radiation Oncology, Cabrini Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Ann Ouyang, MBBS  Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Oscar S Brann, MD, FACP  Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group

Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Postoperative ileus after an open cholecystectomy.
Ogilvie pseudo-obstruction in a septic elderly patient. Note the massive dilatation of the colon, especially the right colon and cecum.
Mechanical bowel obstruction due to a left colon carcinoma. Note the paucity of bowel gas throughout the colon.
Contrast study, in the same patient as in Media File 3, showing the classic "apple-core" lesion of colon carcinoma.
Table. Characteristics of Ileus, Pseudo-obstruction, and Mechanical Obstruction
IleusPseudo-obstructionMechanical Obstruction (Simple)
SymptomsMild abdominal pain, bloating, nausea, vomiting, obstipation, constipationCrampy abdominal pain, constipation, obstipation, nausea, vomiting, anorexiaCrampy abdominal pain, constipation, obstipation, nausea, vomiting, anorexia
Physical Examination FindingsSilent abdomen, distention, tympanicBorborygmi, tympanic, peristaltic waves, hypoactive or hyperactive bowel sounds, distention, localized tendernessBorborygmi, peristaltic waves, high-pitched bowel sounds, rushes, distention, localized tenderness
Plain RadiographsLarge and small bowel dilatation, diaphragm elevatedIsolated large bowel dilatation, diaphragm elevatedBow-shaped loops in ladder pattern, paucity of colonic gas distal to lesion, diaphragm mildly elevated, air-fluid levels
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