Ileus – diagnosis and treatment

1. Big picture

In surgical exams, ileus usually means intestinal obstruction or failure of intestinal propulsion. It is a major emergency topic because the examiner wants you to answer one question immediately:

Is this a simple obstruction that can be decompressed and observed, or is it strangulated/ischemic/perforated and needs urgent surgery?

The practical emergency logic:

Vomiting + abdominal distension + colicky pain + no stool/flatus
        ↓
Suspect ileus / bowel obstruction
        ↓
Resuscitate first: NPO, IV fluids, NG tube, electrolytes, catheter
        ↓
CT to identify level, cause, and ischemia
        ↓
No strangulation/peritonitis → conservative or planned intervention
Strangulation/peritonitis/perforation/closed-loop → emergency surgery

Core oral-exam sentence:

Ileus is impaired intestinal transit due to mechanical obstruction or paralytic bowel failure. Diagnosis is clinical and confirmed mainly by CT. Initial management is resuscitation, decompression, fluid-electrolyte correction, and monitoring; surgery is urgent if there is strangulation, ischemia, perforation, closed-loop obstruction, complete obstruction, incarcerated hernia, or failed conservative treatment.

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