Intestinal Obstruction (Ileus): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate ileus (intestinal obstruction):

  • Abdominal discomfort (abdominal pain; abdominal pain).
  • Meteorism (bloated abdomen)
  • Abnormal bowel sounds (“dead silence “* versus metallic bowel sounds* * ).
  • Nausea (nausea)/vomiting, possibly vomiting (miserere, copremesis).
  • Absence of defecation
  • Symptoms of shock

* VD on paralytic ileus (intestinal paralysis) * * VD on mechanical ileus/intestinal obstruction due to obstruction of the intestinal lumen (sounds of high frequency may occur when the intestinal segments located in front of the stenosis (narrowing) become distended due to gas formation).

Differential diagnosis of “small bowel ileus” versus “large bowel ileus”

Small intestinal ileus Large intestine ileus
Occurrence mostly acute
Symptoms pronounced symptomatology Rather asymptomatic (with the exception of acute onset volvulus); longer history of symptoms with stool changes such as increasing constipation
Most common symptoms
  • Nausea (nausea) /vomiting
  • Intestinal cramps
  • Stool and wind retention
  • Distended abdomen
  • Distended abdomen (about 80%).
  • Intestinal cramps (60%)
  • Stool and wind retention (50%)

Differential diagnosis of “paralytic ileus” versus “mechanical ileus”

Paralytic ileus (synonym: atonic ileus). Mechanical ileus
Meteorism +++ ++ – later +++
Pain Minor pain to constant pain – slow onset (initially only mild diffuse guarding) Crampy abdominal pain that increases in severity as it progresses (colic)
Intestinal activity (early phase) ++ +++ (hyperperistalsis)
Bowel sounds “Dead silence” metallic intestinal sounds
Vomiting Singultus (hiccups), nausea, vomiting predominantly as “overflow” of gastrointestinal contents (miserere) Ileus in the colon (large intestine) leads to very late vomiting

Other indications

  • Any untreated mechanical ileus progresses to paralytic ileus.
  • The full picture of ileus corresponds to that of acute abdomen!

Warning signs (red flags)