Postoperative Ileus Clinical Presentation

Updated: Nov 07, 2018
  • Author: Burt Cagir, MD, FACS; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
  • Print
Presentation

History and Physical Examination

History

Patients with ileus typically have vague, mild abdominal pain, distention, fullness, and bloating. They may report nausea, vomiting, and poor appetite. Abdominal cramping is usually not present. Patients may or may not continue to pass flatus and stool.

A relapse of paralytic ileus is not uncommon in psychiatric patients with a history of ileus; risk factors include being older, having a history of abdominal surgery, or having a longer duration of psychiatric disorders. [21]

In renal transplant candidates with a history of peritoneal dialysis treatment, prior to transplantation, carefully evaluate for symptoms of intermittent bowel obstruction. [22]  Encapsulating peritoneal sclerosis is a rare cause of ileus in patients during or following peritoneal dialysis or renal transplantation. [22]

Physical examination

The abdomen may be distended and tympanic, depending on the degree of abdominal and bowel distention, and may be tender. A distinguishing feature is absent or hypoactive bowel sounds, in contrast to the high-pitched sound of obstruction. The silent abdomen of ileus reveals no discernible peristalsis or succussion splash.