Pseudo-obstruction
Paralytic ileus
Limited to the colon
Involves both small bowel and colon
Occurs in elderly bedridden patients
Any age group particularly in post-operative patients
There will be abdominal distension without pain and tenderness
Abdominal distension associated with pain and tenderness
Increased risk of perforation if caecum is >12 cm in diameter
No such risks
Mechanical Obstruction
Caused by adhesions, volvulus, hernias, intussusception, foreign bodies or neoplasms
Characteristics of Ileus,Pseudo-obstructionand Mechanical Obstruction
Ileus | Pseudo-obstruction | Mechanical obstruction | |
|---|---|---|---|
Symptoms | Nausea, vomiting, mild abdominal pain, bloating, obstipation and constipation | Nausea, vomiting, anorexia, crampy abdominal pain, obstipation and constipation | Nausea, vomiting, anorexia, crampy abdominal pain, obstipation and constipation |
Physical examination | Distension (+), tympanic on percussion, silent abdomen with absent bowel sounds | Distension (+), localised tenderness (+), borborygmi sounds heard. Hypo- or hyperactive bowel sounds heard | Distension (+), localised tenderness (+), borborygmi sounds heard. High-pitched bowel sounds heard |
Plain radiograph features | Diaphragm elevated, small and large bowel dilatation seen
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