[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Postoperative ileus [Conditions](https://durgical.com/en/conditions/) · [Surgery and trauma](https://durgical.com/en/conditions/) # Postoperative ileus Postoperative ileus is a temporary stop of bowel movement after surgery. It causes bloating, vomiting and no passage of gas until the gut wakes up. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Jejunum](https://durgical.com/en/anatomy/jejunum/) - [Ileum](https://durgical.com/en/anatomy/ileum/) - [Transverse colon](https://durgical.com/en/anatomy/transverse-colon/) - [Stomach](https://durgical.com/en/anatomy/stomach/) - [Duodenum](https://durgical.com/en/anatomy/duodenum/) - [Cecum](https://durgical.com/en/anatomy/cecum/) - [Ascending colon](https://durgical.com/en/anatomy/ascending-colon/) - [Descending colon](https://durgical.com/en/anatomy/descending-colon/) - [Sigmoid colon](https://durgical.com/en/anatomy/sigmoid-colon/) - [Peritoneum](https://durgical.com/en/anatomy/peritoneum/) ## Why it happens - [The enteric nervous system, slow waves and GI control](https://durgical.com/en/physiology/the-enteric-nervous-system-slow-waves-and-gi-control/) - [Small bowel and colon motility](https://durgical.com/en/physiology/small-bowel-and-colon-motility/) - [Sympathetic and parasympathetic effects on each organ](https://durgical.com/en/physiology/sympathetic-and-parasympathetic-effects-on-each-organ/) - [The GI tract wall: mucosa, submucosa, muscularis, serosa; enteric plexuses](https://durgical.com/en/histology/the-gi-tract-wall-mucosa-submucosa-muscularis-serosa-enteric-plexuses/) ## What it is A transient loss of coordinated propulsive motility of the gastrointestinal tract after surgery, without mechanical obstruction. Some delay is expected after abdominal surgery; it becomes prolonged ileus when it lasts beyond the usual recovery period, often taken as more than 3–4 days. ## Who gets it Prolonged ileus affects roughly 10–30% of patients after major abdominal surgery, especially bowel resection, and is a leading cause of longer hospital stay and higher costs. Enhanced recovery pathways are being adopted in Colombian and Latin American hospitals to reduce it. ## Causes - Handling of the bowel during abdominal surgery - Opioid analgesia - Inflammatory response to surgery - Electrolyte disturbances, especially low potassium and magnesium - Fluid overload and bowel wall oedema ## Risk factors - Open rather than laparoscopic surgery - Long operations and bowel resection - High opioid use - Blood loss and transfusion - Intra-abdominal complications such as abscess or leak - Older age and prolonged immobility ## Pathophysiology Surgical stress activates inhibitory sympathetic reflexes, and handling of the bowel triggers an inflammatory reaction in the muscle layer that suppresses contractions for days. Opioids acting on gut mu-receptors further slow transit. The small bowel usually recovers within a day, the [stomach](https://durgical.com/en/anatomy/stomach/) in 1–2 days and the colon in 2–3 days. ## Classification - Expected (physiological) postoperative ileus - Prolonged postoperative ileus - Secondary ileus from a complication such as leak, abscess or peritonitis ## Symptoms and signs - Abdominal distension and bloating - Nausea and vomiting - No passage of flatus or stool - Diffuse, mild abdominal discomfort rather than colicky pain - Reduced or absent bowel sounds - Intolerance of oral intake ## Red flags - Fever, tachycardia or peritonism (suggests leak or abscess) - Colicky pain with high-pitched bowel sounds (mechanical obstruction) - Bilious or feculent vomiting with risk of aspiration - Marked caecal distension on imaging - Ileus that does not improve or worsens after several days ## Diagnosis **Clinical** Clinical diagnosis in the days after surgery: distension, vomiting, no flatus and quiet bowel sounds, after excluding complications and mechanical obstruction. **Tests** Electrolytes (potassium, magnesium, calcium), [kidney](https://durgical.com/en/anatomy/kidney/) function, full blood count and inflammatory markers to look for infection. **Imaging** Abdominal X-ray shows uniformly dilated small and large bowel with gas throughout. CT with contrast is used if ileus is prolonged, to rule out mechanical obstruction, leak or abscess. ## Differential diagnosis - Early postoperative small bowel obstruction (adhesions, internal hernia) - Anastomotic leak or intra-abdominal abscess - Acute colonic pseudo-obstruction - Opioid-induced constipation - Electrolyte disturbance or hypothyroidism ## Goal of treatment Support the patient while motility returns, correct the factors that prolong it, and exclude complications that need intervention. ## Treatment **Conservative** Supportive care: intravenous fluids, correction of electrolytes, temporary bowel rest, and nasogastric decompression for persistent vomiting or marked distension. **Medical** Opioid-sparing multimodal analgesia (paracetamol, anti-inflammatory drugs, regional anaesthesia); peripherally acting mu-opioid receptor antagonists are used in some protocols after bowel resection. **Lifestyle** Enhanced recovery measures: early walking, early oral intake, chewing gum and avoiding fluid overload. **Follow-up** Nursing priorities: bowel sounds, abdominal girth, passage of flatus, intake and output, nasogastric drainage, electrolytes, and aspiration risk. ## Drugs for this condition - [Neostigmine](https://durgical.com/en/pharmacology/neostigmine/) ## Complications - Aspiration pneumonia - Dehydration and electrolyte imbalance - Malnutrition with need for parenteral nutrition - Wound dehiscence from raised abdominal pressure - Longer hospital stay ## Prognosis Postoperative ileus resolves in nearly all patients with supportive care; prolonged ileus should prompt a search for an underlying complication. ## Prevention - Enhanced recovery after surgery (ERAS) pathways - Minimally invasive surgery when possible - Opioid-sparing analgesia and epidural analgesia in open surgery - Goal-directed fluids and early mobilisation ## Test yourself Think of the answer, then tap the question to see it. ## In what order does gut motility return after abdominal surgery? Small bowel first (within about a day), then stomach (1–2 days), then colon (2–3 days). ## Which electrolyte disturbances should be corrected in postoperative ileus? Hypokalaemia and hypomagnesaemia (and calcium abnormalities). ## What X-ray pattern distinguishes ileus from mechanical small bowel obstruction? Ileus shows uniformly dilated small and large bowel with gas in the colon and rectum, without a transition point. ## Which class of analgesic is the main modifiable cause of postoperative ileus? Opioids; opioid-sparing multimodal analgesia reduces ileus. ## What is the role of a nasogastric tube in postoperative ileus? Decompression for persistent vomiting or marked distension; it is not used routinely. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/postoperative-ileus/) ## Related conditions - [Paralytic ileus and colonic pseudo-obstruction (Ogilvie)](https://durgical.com/en/conditions/paralytic-ileus-and-colonic-pseudo-obstruction/) - [Small bowel obstruction](https://durgical.com/en/conditions/small-bowel-obstruction/) - [Large bowel obstruction](https://durgical.com/en/conditions/large-bowel-obstruction/) - [Peritonitis](https://durgical.com/en/conditions/peritonitis/) - [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/) - [Wound dehiscence and evisceration](https://durgical.com/en/conditions/wound-dehiscence-and-evisceration/) - [Surgical site infection](https://durgical.com/en/conditions/surgical-site-infection/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Intestinal obstruction and Ileus: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000260.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [Peripherally Acting μ-Opioid Receptor Antagonists in the Management of Postoperative Ileus: a Clinical Review](https://pmc.ncbi.nlm.nih.gov/articles/PMC7851096/) (Journal of Gastrointestinal Surgery, 2021). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/postoperative-ileus/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/postoperative-ileus/