ABSTRACT
Dysregulation of normal bowel movements in absence of obstruction is called ileus. The physiologic postoperative ileus is secondary to colonic dysmotility, as the colon is the last organ to recover (takes 48–72 hours), while the small bowel is the first to recover (takes 0–24 hours), and the paralytic ileus is secondary to small bowel dysmotility. Symptoms of ileus include nausea, vomiting, inability to tolerate any oral intake, abdominal distension, abdominal pain, and obstipation. Physical exam findings include diffuse tympanic percussion, mild tenderness, and reduction of bowel sounds. Management of ileus is conservative and supportive and includes correcting electrolytes, definitive source control of infection, starting the patient on a multimodal pain regimen, nutritional support, bowel rest, bowel decompression when excess vomiting is present, and serial abdominal exams. Resolution of ileus is assessed with a tolerance of diet; the passage of flatus/stool; return of bowel sounds; and decrease in nausea, vomiting, distension, and NGT output.
