Title: What's the Diagnosis? Case by Dr. Zachary Dezman

Posted: 7/1/2013 by Haney Mallemat, MD

Question

65 year-old male presents with nausea and diffuse abdominal pain, 3 days after knee replacement surgery. What's the diagnosis?

Answer

Adynamic ileus

Functional impairment in the transit of intestinal material, in the absence of mechanical obstruction

Common complaints are

Nausea, vomiting, constipation, and obstipation
Diffuse abdominal swelling
Diffuse abdominal pain

Risk factors include

Post-operative state (#1 cause, typically 1-3 days post-op)
Pharmacological agents (e.g., opioids, anti-cholinergics, antihistamines, etc.)
Infections (e.g., pneumonia, pancreatitis, etc.)
Neurological disorders (e.g. diabetic neuropathy)
Abdominal trauma

Imaging reveals distention of both large and small bowel without a transition zone, which differs from a small or large bowel obstruction. Such cases can be difficult to differentiate clinically from one another, so physicians often rely on imaging, specifically CT scanning to define a discrete obstruction versus an ileus.

References

1. Hayden and Sprouse, Bowel Obstruction and Hernia, Med Clin N Amer 29 (2011) 319-345

2. American College of Radiology, Suspected Small Bowel Obstruction, ACR Appropriateness Guidelines, rev. 2010

References

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