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Proportional gaseous dilatation of large and small bowel (SB) due to lack of intestinal peristalsis, not mechanical obstruction
CT or abdominal plain films (supine, upright, decubitus)
Proportional dilatation of SB and colon with no transition point
SB > 3 cm on plain films, 2.5 cm on CT
Air-fluid levels on upright and decubitus films
SB or colonic obstruction
Intestinal pseudoobstruction
Ogilvie syndrome
Aerophagia
Postoperative ileus is most common cause of delayed discharge from hospital
Usually resolves spontaneously in 3-7 days
Most common signs/symptoms
Tympanic abdomen on percussion, lack of flatus
Gaseous distension, abdominal pain, nausea, and vomiting
Absence of bowel sounds on auscultation
Treatment
Treat underlying etiology (e.g., hypokalemia, sepsis)
IV fluids, nasogastric suction
Pitfalls: Ileus plus ascites, and recent bowel surgery, mimic small bowel obstruction (SBO) on plain films
CT can be used to resolve issue if necessary
Adynamic ileus
Proportional gaseous dilatation of large and small bowel (SB) due to lack of intestinal peristalsis, not mechanical obstruction
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