Results: CT was effective (sensitivity and specificity, 100%) in distinguishing between postoperative ileus and complete mechanical small-bowel obstruction.
An abdominal and pelvic CT scan is used to confirm the diagnosis of postoperative ileus only in cases when an x-ray is not diagnostic. An abdomen and pelvis CT scan (with intravenous contrast and oral water soluble contrast) can also distinguish early postoperative ileus from mechanical obstruction.
Your medical history and a physical examination are often enough to diagnose ileus. An X-ray or abdominal ultrasound can confirm the condition by showing swollen and dilated segments of bowel without any mechanical blockage to explain them.
Computed tomography is usually the most appropriate and accurate diagnostic imaging modality for most suspected bowel obstructions.
The symptoms of ileus are abdominal bloating and pain caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and cramps. People may pass watery stool.
Treatment of an ileus requires time and supportive management. Bowel rest, intravenous (IV) fluid therapy, and, if warranted, nasogastric (NG) decompression are important steps. Historically these treatments were thought to lower complications and improve outcomes, but a recent review of the evidence shows otherwise.
Prognosis is generally good as postoperative ileus typically resolves within one to three days after diagnosis with supportive care. Should ileus remain for several days or symptoms continue to worsen despite management, further investigation and imaging is warranted.
“The report authors recommend that all patients with suspected bowel obstruction are promptly sent for a CT scan with contrast, however, a significant number of patients are missing out on those scans, and restricted access to scanning equipment can delay diagnosis and treatment for those that do get them.
Functional ileus
Postoperative (functional) ileus is very common and generally benign, yet it should always be recalled that bowel paralysis after surgery may be due to early postoperative mechanical ileus (torqueing, internal hernia) or septic ileus (abscess, peritonitis).
Bowel movements may be stimulated by prescribing lactulose or neostigmine, but the real breakthrough in a pharmacological treatment of ileus was a drug named alvimopan. Alvimopan is a selective, peripherally acting μ-opioid antagonist which reduces the paralytic effect opiates have on the intestines.
With ileus, this movement slows down or stops completely. As a result, waste can't move through the bowels and out of the body.
Ileus Symptoms
Feel bloated from a buildup of gas and liquid in your belly. Feel sick to your stomach (nausea) Throw up (vomit) Find it hard to poop (constipation)
Signs of Ileus in the ICU patient can include abdominal distention, intolerance to enteral feeds, increased gastric output, increase in abdominal pressure, decreased flatus, decreased bowel sounds and decreased stool output. Sypmptoms of ileus can include abdominal pain, nausea,vomiting.
As with the ALIF procedure, most cases of ileus resolve within a week after surgery.
Examples of conditions that we would not diagnose on CT scan or ultrasound include viral infections ('the stomach flu'), inflammation or ulcers in the stomach lining, inflammatory bowel disease (such as Crohn's Disease or Ulcerative Colitis), irritable bowel syndrome or maldigestion, pelvic floor dysfunction, strains ...
CT enterography is an imaging test that uses CT imagery and a contrast material to view the small intestine. The procedure allows your healthcare provider to determine what is causing your condition. He or she can also tell how well you're responding to treatment for a health issue, such as Crohn's disease.
Many surgeons have suggested that postoperative ileus after a bowel resection should last 3 days following a laparoscopic surgery and 5 days in an open approach (16).
The most common symptoms are: Abdominal pain. Abdominal swelling and bloating (called abdominal distension) Nausea and vomiting.
Without treatment, it can become life-threatening. If ileus persists, it can cut off blood supply to the intestines and cause tissue death. This can result in an intestinal tear or infection of the abdominal cavity that can be life threatening. Ileus occurs when the intestines do not move food through in the usual way.
CT has the highest accuracy among the imaging modalities for detection of abnormal gas in the abdomen and pelvis. (1-3) Abnormal gas can be more easily observed in the lung or bone window settings compared to the soft tissue window setting (Fig. 2).
Degree of confidence
The reported sensitivity of CT scanning for detecting small-bowel obstruction is 78-100% in high-grade or complete obstruction. If the obstruction is partial or intermittent, the accuracy is low. CT can be helpful in excluding closed-loop small-bowel obstruction, according to Makar et al.
In cases of ileus, vomiting is usually infrequent; pain is mild, and distention is moderate to severe. Typically, the pain in small-bowel obstruction is crampy, with paroxysms occurring at 4- to 5-min intervals for proximal obstruction and less frequently for more distal obstruction.
Patients with post-operative ileus, opioid-induced constipation, or a soft stool will benefit from a stimulant laxative, such as senna or picosulphate. *In resistant cases, additional therapy can be given via manual evacuation.
Physiologic ileus spontaneously resolves within 2-3 days, after sigmoid motility returns to normal. Ileus that persists for more than 3 days following surgery is termed postoperative adynamic ileus, paralytic ileus, or functional ileus.
Overall, the prognosis of gallstone ileus is poor, with mortality rates up to 20%, mainly because of the delayed diagnosis and coexistence of comorbid conditions, more frequent in the elderly population [12].