Ileus

Gangrene of the bowel causing gangrenous ileus
Pronunciation|

* /ˈɪliəs/

Specialty| General surgery

Ileus is a disruption of the normal propulsive ability of the intestine. It can be caused by lack of peristalsis or by mechanical obstruction.[1] The word 'ileus' is from Ancient Greek eileós (εἰλεός, "intestinal obstruction"). The term 'subileus' refers to a partial obstruction.[2]

## Contents

* 1 Signs and symptoms
* 2 Cause
* 2.1 Bowel obstruction
* 2.2 Intestinal paralysis
* 2.3 Risk factors
* 3 Treatment
* 4 Other animals
* 5 Terminology
* 6 References
* 7 External links

## Signs and symptoms

Symptoms of ileus include, but are not limited to:[citation needed]

* moderate to severe, diffuse abdominal pain
* constipation
* abdominal distension
* nausea/vomiting, especially after meals
* vomiting of bilious fluid (green or yellowish-green in colour)
* flatulence and/or lack of bowel movement
* excessive belching

## Cause

Decreased propulsive ability may be broadly classified as caused either by bowel obstruction or intestinal atony or paralysis. However, instances with symptoms and signs of a bowel obstruction occur, but with the absence of a mechanical obstruction, mainly in acute colonic pseudo-obstruction, Ogilvie's syndrome.[citation needed] In 2023, The US FDA reported gastrointestinal ileus as an adverse effect of the medication semaglutide, with frequency and causal relationship unknown.[3]

### Bowel obstruction

Main page: Medicine:Bowel obstruction

A bowel obstruction is generally a mechanical obstruction of the gastrointestinal tract.

### Intestinal paralysis

Paralysis of the intestine is often termed paralytic ileus, in which the intestinal paralysis not need to be complete, but it must be sufficient to prohibit the passage of food through the intestine and lead to intestinal blockage. Paralytic ileus is a common side effect of some types of surgery, commonly called postsurgical ileus. It can also result from certain drugs and from various injuries and illnesses, such as acute pancreatitis. Paralytic ileus causes constipation and bloating. On listening to the abdomen with a stethoscope, no bowel sounds are heard because the bowel is inactive.[citation needed]

A temporary paralysis of a portion of the intestines occurs typically after abdominal surgery. Since the intestinal content of this portion is unable to move forward, food or drink should be avoided until peristaltic sound is heard, by auscultation (use of a stethoscope) of the area where this portion lies. Intestinal atony or paralysis may be caused by inhibitory neural reflexes, inflammation or other implication of neurohumoral peptides.[citation needed]

### Risk factors

* gastrointestinal surgery or other GI procedures
* electrolyte imbalance (Namely hypokalemia and hypercalcemia)
* diabetic ketoacidosis (DKA),[4] and other causes of metabolic acidosis
* hypothyroidism
* diabetes
* medications (e.g. opioids or antimuscarinics)
* severe illness (Inflammation with peritonitis)
* spinal cord injury, those with injury above thoracic vertebrae 5 (T5) will have hypomotility problems within the bowel
* acute intermittent porphyria

## Treatment

Traditionally, nothing by mouth was considered to be mandatory in all cases, but gentle feeding by enteral feeding tube may help to restore motility by triggering the gut's normal feedback signals, so this is the recommended management initially.[5] When the patient has severe, persistent signs that motility is completely disrupted, nasogastric suction and parenteral nutrition may be required until passage is restored. In such cases, continuing aggressive enteral feeding causes a risk of perforating the gut.

Several options are available in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose, erythromycin or, in severe cases that are thought to have a neurological component (such as Ogilvie's syndrome), neostigmine. There is also evidence from a systematic review of randomized controlled trials that chewing gum, as a form of 'sham feeding', may stimulate gastrointestinal motility in the post-operative period and reduce the duration of postoperative ileus.[6]

If possible the underlying cause is corrected (e.g. replace electrolytes).

## Other animals

Ileus is a cause of colic in horses due to functional obstruction of the intestines. It is most commonly seen in horses postoperatively, especially following colic surgery.[7] Horses experiencing ileus are at risk for gastric rupture due to rapid reflux build-up, and require intense medical management with frequent nasogastric intubation.[7] Ileus may increase adhesion formation, because intestinal segments have more prolonged contact and intestinal distention causes serosal injury and ischemia. It is usually treated with aggressive fluid support, prokinetics, and anti-inflammatories.[7]

## Terminology

ICD-10 coding reflects both impaired-peristalsis senses and mechanical-obstruction senses of the term as modified by various adjectives.[1] Some authors have argued for trying to reserve the term for the impaired-peristalsis senses,[8][9] under which prescription certain older terms such as "gallstone ileus" and "meconium ileus", although now technically misnomers, are still accepted as correct owing to their long-established usage.[10]

## References

1. ↑ 1.0 1.1 World Health Organization (WHO), ICD-10 coding. K56.x series., https://icd.who.int/browse10/2010/en#!K56.0, retrieved 2021-07-28.
2. ↑ "Ileus Intestinal Obstruction". https://www.baermed.ch/en/intestinal_obstruction_content
1--1109.html.
3. ↑ Zoler, Mitchel L. (28 September 2023). "FDA Gives Ozempic Two Drug Safety–Related Label Changes". https://www.medscape.com/viewarticle/996912.
4. ↑ "Management of hyperglycemic crises in patients with diabetes". Diabetes Care 24 (1): 131–53. January 2001. doi:10.2337/diacare.24.1.131. PMID 11194218. http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=11194218.
5. ↑ "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)". JPEN J Parenter Enteral Nutr 33 (3): 277–316. 2009. doi:10.1177/0148607109335234. PMID 19398613. http://pen.sagepub.com/cgi/pmidlookup?view=long&pmid=19398613.
6. ↑ "Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery". World J Surg 33 (12): 2557–66. December 2009. doi:10.1007/s00268-009-0104-5. PMID 19763686.
7. ↑ 7.0 7.1 7.2 Larson, Erica. "Equine Postoperative Ileus Insights". The Horse. http://www.thehorse.com/articles/32229/equine-postoperative-ileus-insights.
8. ↑ "The biological basis of modern surgical practice". Sabiston Textbook of Surgery (17th ed.). Elsevier Saunders. 2004.
9. ↑ "Postoperative ileus". Dig. Dis. Sci. 35 (1): 121–32. January 1990. doi:10.1007/bf01537233. PMID 2403907.
10. ↑ "Intestinal obstruction and ileus". Sleisenger & Fordtran's Gastrointestinal and Liver Disease (8th ed.). Elsevier Saunders. 2006. https://archive.org/details/sleisengerfordtr0000unse_j1o5.

## External links

Classification|

* ICD-10: K31.5, K56.0, K56.3, K56.7, P75, P76.1
* ICD-9-CM: 537.2, 560.1, 560.31, 777.1, 777.4
* MeSH: D045823
* DiseasesDB: 6706

|

External resources|

* MedlinePlus: 000260
* eMedicine: article/178948

* MedlinePlus Encyclopedia Intestinal Obstruction
* Patient UK: Intestinal Obstruction and Ileus
* PubMed Health: Intestinal obstruction
* Ileus at eMedicine
* Merck Manual Professional: Ileus

* v
* t
* e

Diseases of the digestive system (primarily K20–K93, 530–579)

Upper GI tract|

| Esophagus|

* Esophagitis
* Candidal
* Eosinophilic
* Herpetiform
* Rupture
* Boerhaave syndrome
* Mallory–Weiss syndrome
* UES
* Zenker's diverticulum
* LES
* Barrett's esophagus
* Esophageal motility disorder
* Nutcracker esophagus
* Achalasia
* Diffuse esophageal spasm
* Gastroesophageal reflux disease (GERD)
* Laryngopharyngeal reflux (LPR)
* Esophageal stricture
* Megaesophagus

|

Stomach|

* Gastritis
* Atrophic
* Ménétrier's disease
* Gastroenteritis
* Peptic (gastric) ulcer
* Cushing ulcer
* Dieulafoy's lesion
* Dyspepsia
* Pyloric stenosis
* Achlorhydria
* Gastroparesis
* Gastroptosis
* Portal hypertensive gastropathy
* Gastric antral vascular ectasia
* Gastric dumping syndrome
* Gastric volvulus
* Buried bumper syndrome

Lower GI tract:
Intestinal/
Enteropathy|

| Small intestine
(Duodenum/Jejunum/Ileum)|

* Enteritis
* Duodenitis
* Jejunitis
* Ileitis
* Peptic (duodenal) ulcer
* Curling's ulcer
* Malabsorption: Coeliac
* Tropical sprue
* Blind loop syndrome
* Small bowel bacterial overgrowth syndrome
* Whipple's
* Short bowel syndrome
* Steatorrhea
* Milroy disease
* Bile acid malabsorption

|

Large intestine
(Appendix/Colon)|

* Appendicitis
* Colitis
* Pseudomembranous
* Ulcerative
* Ischemic
* Microscopic
* Collagenous
* Lymphocytic
* Functional colonic disease
* IBS
* Intestinal pseudoobstruction / Ogilvie syndrome
* Megacolon / Toxic megacolon
* Diverticulitis/Diverticulosis

Large and/or small|

* Enterocolitis
* Necrotizing
* Gastroenterocolitis
* IBD
* Crohn's disease
* Vascular: Abdominal angina
* Mesenteric ischemia
* Angiodysplasia
* Bowel obstruction: Ileus
* Intussusception
* Volvulus
* Fecal impaction
* Constipation
* Diarrhea
* Infectious
* Intestinal adhesions

Rectum|

* Proctitis
* Radiation proctitis
* Proctalgia fugax
* Rectal prolapse
* Anismus

Anal canal|

* Anal fissure/Anal fistula
* Anal abscess
* Hemorrhoid
* Anal dysplasia
* Pruritus ani

GI bleeding/BIS|

* Upper
* Hematemesis
* Melena
* Lower
* Hematochezia

Accessory|

| Liver|

* Hepatitis
* Viral hepatitis
* Autoimmune hepatitis
* Alcoholic hepatitis
* Cirrhosis
* PBC
* Fatty liver
* NASH
* Vascular
* Budd–Chiari syndrome
* Hepatic veno-occlusive disease
* Portal hypertension
* Nutmeg liver
* Alcoholic liver disease
* Liver failure
* Hepatic encephalopathy
* Acute liver failure
* Liver abscess
* Pyogenic
* Amoebic
* Hepatorenal syndrome
* Peliosis hepatis
* Metabolic disorders
* Wilson's disease
* Hemochromatosis

|

Gallbladder|

* Cholecystitis
* Gallstones/Cholecystolithiasis
* Cholesterolosis
* Adenomyomatosis
* Postcholecystectomy syndrome
* Porcelain gallbladder

Bile duct/
Other biliary tree|

* Cholangitis
* Primary sclerosing cholangitis
* Secondary sclerosing cholangitis
* Ascending
* Cholestasis/Mirizzi's syndrome
* Biliary fistula
* Haemobilia
* Gallstones/Cholelithiasis

* Common bile duct
* Choledocholithiasis
* Biliary dyskinesia
* Sphincter of Oddi dysfunction

Pancreatic|

* Pancreatitis
* Acute
* Chronic
* Hereditary
* Pancreatic abscess
* Pancreatic pseudocyst
* Exocrine pancreatic insufficiency
* Pancreatic fistula

Abdominopelvic|

| Hernia|

* Diaphragmatic
* Congenital
* Hiatus

* Inguinal
* Indirect
* Direct
* Umbilical
* Femoral
* Obturator
* Spigelian

* Lumbar
* Petit's
* Grynfeltt-Lesshaft

* Undefined location
* Incisional
* Internal hernia
* Richter's

|

Peritoneal|

* Peritonitis
* Spontaneous bacterial peritonitis
* Hemoperitoneum
* Pneumoperitoneum

* v
* t
* e

Certain conditions originating in the perinatal period / fetal disease (P, 760–779)

Maternal factors and
complications of pregnancy,
labour and delivery|

| placenta:|

* Placenta praevia
* Placental insufficiency
* Twin-to-twin transfusion syndrome

|

chorion/amnion:|

* Chorioamnionitis

umbilical cord:|

* Umbilical cord prolapse
* Nuchal cord
* Single umbilical artery

presentation:|

* Breech birth
* Asynclitism
* Shoulder presentation

Length of gestation
and fetal growth|

* Small for gestational age/Large for gestational age
* Preterm birth/Postmature birth
* Intrauterine growth restriction

Birth trauma|

* scalp
* Cephalhematoma
* Chignon
* Caput succedaneum
* Subgaleal hemorrhage
* Brachial plexus lesion
* Erb's palsy
* Klumpke paralysis

By system|

| Respiratory|

* Intrauterine hypoxia
* Infant respiratory distress syndrome
* Transient tachypnea of the newborn
* Meconium aspiration syndrome
* pleural disease
* Pneumothorax
* Pneumomediastinum
* Wilson–Mikity syndrome
* Bronchopulmonary dysplasia

|

Cardiovascular|

* Pneumopericardium
* Persistent fetal circulation

Haemorrhagic and
hematologic disease|

* Vitamin K deficiency bleeding

* HDN
* ABO
* Anti-Kell
* Rh c
* Rh D
* Rh E
* Hydrops fetalis
* Hyperbilirubinemia
* Kernicterus
* Neonatal jaundice

* Velamentous cord insertion
* Intraventricular hemorrhage
* Germinal matrix hemorrhage
* Anemia of prematurity

Digestive|

* Ileus
* Necrotizing enterocolitis
* Meconium peritonitis

Integument and
thermoregulation|

* Erythema toxicum
* Sclerema neonatorum

Nervous system|

* Perinatal asphyxia
* Periventricular leukomalacia

Musculoskeletal|

* Gray baby syndrome
* muscle tone
* Congenital hypertonia
* Congenital hypotonia

Infectious|

* Vertically transmitted infection
* Neonatal infection
* Congenital rubella syndrome
* Neonatal herpes simplex
* Mycoplasma hominis infection
* Ureaplasma urealyticum infection
* Omphalitis
* Neonatal sepsis
* Group B streptococcal infection
* Neonatal conjunctivitis

Other|

* Miscarriage
* Perinatal mortality
* Stillbirth
* Infant mortality
* Neonatal withdrawal

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