Adynamic ileus

Last revised by Mohammad Taghi Niknejad on 27 Dec 2023

Adynamic ileus is the failure of passage of enteric contents through the small bowel and colon that are not mechanically obstructed; i.e. it represents a paralysis of intestinal motility.

Patients may be asymptomatic or present with symptoms similar to mechanical bowel obstruction such as nausea/vomiting, distension, and reduced or absent bowel movements. Bowel sounds may also be absent 12

Adynamic ileus can be caused by several conditions:

The cause of ileus is thought to be complex and multifactorial, involving bowel inflammation 6, inhibitory neural reflexes 7, and neurohormonal peptides 8.

Some degree of ileus is a normal and expected finding after abdominal surgery, including C-section 9. Conventional recovery times have been reported as 4:

  • small intestine: 0-24 hours 
  • stomach: 24-48 hours
  • colon: 48-72 hours

These intervals, however, may be overestimations 5.

Risk factors for postoperative ileus are: operative difficulty, operation more than 3 hours, bowel handling, drop in hematocrit levels, need of transfusion, increasing crystalloid administration, and lack of mobility after operation 12.

Prolonged postoperative ileus (>72 hours) has been termed "paralytic" ileus by some and is concerning for small bowel obstruction, bowel perforation, peritonitis, and intra-abdominal abscess. 

Improving postoperative ileus is often determined clinically as much as radiographically, with the resumption of oral intake and flatus.

  • generalized, uniform, gaseous distension of the large and small bowel
  • when localized, there may be a sentinel loop

Improving gastric motility, boosting the nourishment status of the patient, and strengthening the stability of the interior environment are the main motives of therapy 11.

"Ileus" ultimately derives from είλειν ("to twist"), which also gave rise to the section of the bowel termed the "ileum". At one time what we now call ileus had been called the "iliack passion" because it was believed that the intestines were twisted 3.

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