Disease Description (Causes and Symptoms)
Ileus is a condition in which the small or large intestine is partially or completely obstructed, preventing the passage of intestinal contents (food, digestive juices, and gas), thereby causing increased intestinal pressure, intestinal distension, and impaired digestion and absorption.
Main causes
- Mechanical obstruction: postoperative adhesions, tumors (small intestine cancer·colorectal cancer), incarceration due to a hernia, intussusception, volvulus, etc.
- Paralytic (functional) obstruction: decreased intestinal motility due to peritonitis, acute pancreatitis·cholecystitis, abdominal trauma·immediately after surgery, certain medications (analgesics·anticholinergics, etc.), etc.
Summary of pathophysiology - Intestinal contents accumulate above the site of obstruction, causing distension·pain·vomiting → increased intraluminal pressure reduces blood flow → increased risk of intestinal mucosal ischemia·necrosis·perforation and sepsis
Main symptoms - Intermittent (paroxysmal) abdominal pain (cramping), abdominal distension, vomiting (severe and bilious in upper small-intestine obstruction; feculent vomiting may occur as time passes), cessation of bowel movements·gas passage (in complete obstruction), dehydration·tachycardia·hypotension, fever·increased white blood cell count (in cases of necrosis·perforation·infection)
Physical examination findings - Early mechanical obstruction: hyperactive bowel sounds (high-pitched bowel sounds)
- Paralytic ileus or advanced condition: decreased or absent bowel sounds
Treatment Methods (Standard Treatment·Medications·Procedures/Surgery·Lifestyle Management and Precautions)
Initial management (emergency·primary)
- Nothing by mouth (NPO), intravenous fluids (fluid·electrolyte correction), correction of electrolyte·acid-base status
- Gastrointestinal decompression: aspiration of gastric contents (decompression) by inserting a nasogastric tube (Levin or nasogastric tube)
- Control of pain·vomiting (antiemetics and analgesics as needed—use carefully so as not to mask diagnostic signs), broad-spectrum antibiotics if necessary (when perforation·peritonitis is suspected)
Diagnostic tests - Upright plain abdominal X-ray: suspected intestinal obstruction based on observation of air-fluid levels
- Contrast-enhanced abdominal CT: most useful for identifying the site of obstruction·transition point·intestinal ischemia·cause (tumor·hernia, etc.)
- Blood tests: CBC, electrolytes, renal function, blood gas·lactate — important when intestinal ischemia is suspected
Criteria for conservative (nonoperative) treatment - If there is partial obstruction, no evidence of necrosis·perforation·peritonitis, and symptoms improve with decompression·fluid therapy, observation and continued conservative management may be appropriate
Indications for surgery - Emergency surgery is indicated for complete obstruction, evidence of intestinal ischemia·necrosis·perforation or peritonitis, failure of conservative treatment, progressive shock, or rapid worsening of symptoms
Examples of surgical treatment - Adhesiolysis, resection of necrotic intestine followed by anastomosis or stoma formation, hernia repair·correction, reduction of intussusception in children with an air·barium enema, and, in some cases, endoscopic stent placement for malignant colorectal obstruction
Follow-up·lifestyle management and precautions - When symptoms improve after fasting, gradually resume oral intake (clear liquids → semi-liquid diet → regular diet)
- Carefully correct dehydration·electrolyte abnormalities and monitor bowel movements·gas passage
- Analgesics (especially opioids) may suppress intestinal motility, so discuss their necessity and dosage with a doctor
- Early medical evaluation is recommended if there is a history of abdominal surgery (risk of adhesions) or signs of a hernia
Risk of complications - Intestinal ischemia·necrosis, perforation, peritonitis, sepsis, electrolyte abnormalities·shock
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
Items to bring
- List of medications currently being taken (name·dose·time of administration) and recent prescriptions
- Past medical history·surgical records (especially abdominal surgery·hernia·history of cancer)
- Films or a CD of recent test results or imaging (abdominal X-ray/CT, etc.), and test reports
- Onset and course of symptoms (specific timing·frequency·volume), and a photo or record of vomit (if available)
- Recent weight changes, time of the last bowel movement·gas passage, presence of fever, and whether urine output has decreased
Useful items to record for the outpatient visit - Characteristics of pain (paroxysmal·continuous), number of vomiting episodes and contents (bilious·feculent), degree of abdominal distension, and changes in meals·medications
Restrictions/precautions before the visit - Visit while fasting (if instructed by a doctor), and avoid consuming food orally without a prescription or instructions
Examples of simple questions to ask at an outpatient visit (to prepare for asking the doctor) - “I have a history of abdominal surgery. How likely is it that these symptoms are caused by adhesions?”
- “What are the criteria for determining whether hospitalization·surgery is needed in my current condition?”
General Example Questions to Ask the Doctor
- “Given my current condition, how likely is it that I will improve with conservative treatment (decompression·fluid therapy)?”
- “If surgery is necessary, what type of surgery is expected, and what is the risk of complications?”
- “Besides fluid·electrolyte correction, is there anything I can do at home to manage my condition?”
- “What should I avoid in terms of lifestyle (diet·medications·activity) during or after treatment?”
Disease-Specific Example Questions
- “I have had abdominal surgery in the past (or repeated intestinal surgery). Are there specific ways to prevent recurrent adhesive intestinal obstruction?”
- “A localized transition point was observed on my abdominal CT. In this case, is nonsurgical treatment (such as an endoscopic stent) possible, and what are the indications for surgery? Please explain.”
(Note: The above information summarizes general diagnostic·treatment guidelines. Because testing·treatment plans may vary depending on the individual patient’s condition, be sure to consult the treating medical professionals.)