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KEY FACTS
Terminology
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Proportional gaseous dilatation of large and small bowel (SB) due to lack of intestinal peristalsis, not mechanical obstruction
Imaging
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CT or abdominal plain films (supine, upright, decubitus)
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Proportional dilatation of SB and colon with no transition point
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SB > 3 cm on plain films, 2.5 cm on CT
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Air-fluid levels on upright and decubitus films
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Top Differential Diagnoses
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SB or colonic obstruction
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Intestinal pseudoobstruction
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Ogilvie syndrome
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Aerophagia
Clinical Issues
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Postoperative ileus is most common cause of delayed discharge from hospital
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Usually resolves spontaneously in 3-7 days
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Most common signs/symptoms
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Tympanic abdomen on percussion, lack of flatus
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Gaseous distension, abdominal pain, nausea, and vomiting
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Absence of bowel sounds on auscultation
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Treatment
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Treat underlying etiology (e.g., hypokalemia, sepsis)
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IV fluids, nasogastric suction
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Diagnostic Checklist
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Pitfalls: Ileus plus ascites, and recent bowel surgery, mimic small bowel obstruction (SBO) on plain films
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CT can be used to resolve issue if necessary
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Supine abdominal radiograph in an 88-year-old man with abdominal distension and hypokalemia from diuretic use shows proportional dilation
of the large and small bowel with no clear transition point. The ileus resolved with electrolyte replacement.
of the large and small bowel with no clear transition point. The ileus resolved with electrolyte replacement.
Supine radiograph in a 90-year-old woman with abdominal distension and pain following a hip "pinning" shows gaseous dilation of the colon
and the small bowel
in a uniform pattern with no point of transition.
and the small bowel in a uniform pattern with no point of transition.
This 52-year-old woman has cirrhosis with increasing abdominal distention and nausea. A supine abdominal film, requested to evaluate possible SBO, shows a dilated transverse colon
and small bowel
, but no gas in other colon segments. Ascites
fills the pelvis and paracolic gutters.
and small bowel , but no gas in other colon segments. Ascites fills the pelvis and paracolic gutters.
CT in the same patient shows ascites
and fluid-distended bowel
. Gas fills only a portion of the nondependent bowel, while the dependent SB & colon
are fluid-filled & less dilated. This may be misinterpreted as SB obstruction.
and fluid-distended bowel . Gas fills only a portion of the nondependent bowel, while the dependent SB & colon are fluid-filled & less dilated. This may be misinterpreted as SB obstruction.
TERMINOLOGY
Synonyms
-
Adynamic ileus
Definitions
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Proportional gaseous dilatation of large and small bowel (SB) due to lack of intestinal peristalsis, not mechanical obstruction
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