Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 15-28: Intestinal Motility Disorders + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Precipitating factors Surgery Peritonitis Electrolyte abnormalities Severe medical illness Nausea, vomiting, obstipation, distention Minimal abdominal tenderness; decreased bowel sounds Plain abdominal radiography with gas and fluid distention in small and large bowel +++ General Considerations ++ Neurogenic failure or loss of peristalsis in the intestine in the absence of any mechanical obstruction Common in hospitalized patients as a result of the following Intra-abdominal processes, such as Recent gastrointestinal or abdominal surgery Peritoneal irritation (peritonitis, pancreatitis, ruptured viscus, hemorrhage) Severe medical illness, such as Pneumonia Respiratory failure requiring intubation Sepsis or severe infections Uremia Diabetic ketoacidosis Electrolyte abnormalities (hypokalemia, hypercalcemia, hypomagnesemia, hypophosphatemia) Medications, such as Opioids Anticholinergics Phenothiazines Postoperative ileus is reduced by Use of patient-controlled or epidural analgesia Avoidance of intravenous opioids Early ambulation Gum chewing Initiation of a clear liquid diet + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Mild diffuse, continuous abdominal discomfort Nausea and vomiting Generalized abdominal distention Minimal abdominal tenderness No signs of peritoneal irritation Bowel sounds are diminished to absent +++ Differential Diagnosis ++ Mechanical obstruction of small intestine or proximal colon, eg, adhesions, volvulus, Crohn disease Chronic intestinal pseudo-obstruction + Diagnosis Download Section PDF Listen +++ +++ Laboratory Tests ++ Obtain serum electrolytes, potassium, magnesium, phosphorus, and calcium +++ Imaging Studies ++ Plain abdominal radiography: air-fluid levels, distended gas-filled loops of small and large intestine Limited barium small bowel series or a CT scan can help exclude mechanical obstruction + Treatment Download Section PDF Listen +++ +++ Medications ++ Alvimopan A peripherally acting mu-opioid receptor antagonist with limited absorption or systemic activity that reverses opioid-induced inhibition of intestinal motility Reduces time to first flatus, bowel movement, solid meal, and hospital discharge in postoperative patients May be considered in patients undergoing partial large or small bowel resection when postoperative opioid therapy is anticipated +++ Therapeutic Procedures ++ Treat underlying primary medical or surgical illness Nasogastric suction for discomfort or vomiting Restrict oral intake, administer intravenous fluids Liberalize diet gradually as bowel function returns Minimize anticholinergic and opioid medications Severe or prolonged ileus requires nasogastric suction and infusion of parenteral fluids and electrolytes + Outcome Download Section PDF Listen +++ +++ Follow-Up ++ Return of bowel function usually heralded by return of appetite and passage of flatus Serial plain film radiography and/or abdominal CT warranted for persistent or worsening symptoms to distinguish from mechanical obstruction +++ Prognosis ++ Ileus usually resolves within 48–72 h Following surgery, small intestinal motility normalizes first (within hours), followed by stomach (24–48 h) and colon (48–72 h) +++ When to Refer ++ Persistent ileus lasting more than 3–5 days warrants further evaluation for underlying cause and to exclude mechanical obstruction +++ When to Admit ++ All patients with ileus require admission for intravenous fluids + References Download Section PDF Listen +++ + +Güngördük K et al. Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial. Am J Obstet Gynecol. 2017 Feb;216(2):145.e1–145. [PubMed: 27780709] + +Sultan S et al. Alvimopan for recovery of bowel function after radical cystectomy. Cochrane Database Syst Rev. 2017 May 2;5:CD012111. [PubMed: 28462518] + +Taylor RW. Gut motility issues in critical illness. Crit Care Clin. 2016 Apr;32(2):191–201. [PubMed: 27016161]