History and exam
Key diagnostic factors
common
nausea and vomiting
abdominal distention
Almost always present but nonspecific.[3]
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 as to other serious intra-abdominal disease processes.
Increasing amounts of pain or opioid requirements 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 (severe constipation with no passage of stool or flatus)
Decreased flatus and passage of stool is a common finding.
However, the presence of bowel movements does not exclude ileus.
discomfort and abdominal cramping
Usually without significant pain.
decreased or hypoactive bowel sounds
Decreased bowel sounds are a nonspecific sign but are typically found in ileus. This is different from small bowel obstruction, where hyperactive bowel sounds may be found.
uncommon
hypovolemia
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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