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 |
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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)
- Females: Abdominal discomfort (abdominal pain; abdominal pain) + nausea (nausea)/vomiting + constipation (constipation) → think of: Ileus due to ovarian cancer metastases (daughter tumors of an ovarian cancer).