History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include abdominal and non-abdominal surgery; acute conditions (e.g., myocardial infarction, pneumonia, acute cholecystitis, pancreatitis, trauma); and systemic conditions (e.g., sepsis).
nausea and vomiting
abdominal distention or tenderness
Present in 71% of patients with postoperative ileus.[35]
no features of mechanical obstruction or peritoneal inflammation (e.g., abdominal hernia, peritoneal signs)
It is important to look for any evidence of mechanical obstruction (e.g., hernia) as the treatment differs and a delay in diagnosis and treatment can have serious consequences.
Evidence of peritoneal inflammation, such as peritonitis and rebound tenderness, is an unusual finding and should alert to other serious intra-abdominal disease processes.
An increasing amount of pain or opioid requirement is another sign that the patient may have an acute bowel obstruction or other intra-abdominal disease rather than a simple ileus.
Other diagnostic factors
common
obstipation (absolute constipation)
Severe constipation with no passage of stool or flatus is a common finding.
However, the presence of bowel movements or 'discharge' (passage of liquid stool or mucus) does not exclude ileus.
discomfort and abdominal pain
Discomfort from gaseous distention is common, with pain. Cramping or colicky pain is unusual in ileus; when present they indicate gut muscle activity.
decreased or hypoactive bowel sounds
Decreased bowel sounds are a non-specific sign but are typically found in ileus.
uncommon
hypovolaemia
Not specific but may be present in patients with limited oral intake and vomiting.
Tachycardia, hypotension, and oliguria are specific findings in this condition.
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