Ileus in Adults

Abstract

Background: Ileus is one of the more common suspected diagnoses in everyday clinical practice. The term can refer either to mechanical or to functional ileus. Any physician who takes care of patients can be confronted with these entities; thus, all should be familiar with them and competent in their management.

Methods: Recommendations are summarized for the diagnostic evaluation and treatment of ileus of various causes on the basis of a selective literature review.

Results: The manifestations of ileus and its degree of severity generally depend on the site of blockage. The rule until recently was that a patient with suspected mechanical ileus should be taken to surgery within 12 hours; today, however, ileus-particularly of the small bowel-can often be successfully treated conservatively. Likewise, functional ileus only rarely requires surgery: supportive measures, depending on the etiology, usually suffice.

Conclusion: Proper treatment depends on the timely determination of the pathogenesis (mechanical versus functional) and on close interdisciplinary collaboration. A special challenge is posed by patients with peritoneal involvement with cancer who present with symptoms of ileus, in whom a clear distinction between mechanical and functional causation cannot always be drawn.

Figure 1: Abdominal computed tomography (CT) and intraoperative findings

Figure 2

Multimodal perioperative fast-track concept [modified from Vilz (25)]; EDC, epidural catheter

Figure 3

Algorithm for the treatment of opioid-induced constipation or ileus (after [33]); s.c., subcutaneously; p.o., per os

Figure 4

The treatment of suspected ileus and known peritoneal carcinosis (after [40]); PPI, proton-pump inhibitors