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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
- 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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