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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Ileus differential diagnosis

Introduction

Overview

Overview

Ileus must be differentiated from other diseases that cause abdominal pain, constipation, nausea and vomiting such as small bowel obstruction, gastric outlet obstruction, gastroparesis, gastrointestinal perforation, acute cholecystitis, acute pancreatitis, chronic pancreatitis, liver abscess and spontaneous bacterial peritonitis.

Differential Diagnosis

Differential Diagnosis

Ileus must be differentiated from other diseases that cause abdominal pain, constipation, nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function tests, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X-ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram, US = Ultrasound

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Ileus Diffuse – – + – + – ± – + – ± Hypoactive
  • Multiple air–fluid levels throughout the abdomen
  • Dilatation of both the large and small intestine
  • Hypoactive bowel sounds
  • Most commonly seen in the postoperative state
Small bowel obstruction Diffuse + − + − + − + − + + ± Hyperactive then absent
  • “Target sign”– , indicative of intussusception
  • Venous cut-off sign” – suggests thrombosis
Gastric outlet obstruction Epigastric − − ± − − − + − − − − Hyperactive
  • Succussion splash
Gastroparesis Epigastric − − + − − − + − ± − − Hyperactive/hypoactive
  • Scintigraphic gastric emptying
Gastrointestinal perforation Diffuse + ± – ± − − − + + + ± Hyperactive/hypoactive
Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Acute cholecystitis RUQ + − + + − − − − − − − Hypoactive Ultrasound shows:
Acute pancreatitis Epigastric + − + ± − − + − ± − − N
  • Pain radiation to back
Chronic pancreatitis Epigastric − − ± ± − + + − − − − N
Liver abscess RUQ + + + + − ± + − + + ± Normal or hypoactive
  • Both lobes are commonly involved
Spontaneous bacterial peritonitis Diffuse + − − Positive in cirrhotic patients − + − − ± + + Hypoactive
References

References

  1. ↑ Johnson CD, Ellis H (1990). “Gastric outlet obstruction now predicts malignancy”. Br J Surg. 77 (9): 1023–4. PMID 2207566.
  2. ↑ Shone DN, Nikoomanesh P, Smith-Meek MM, Bender JS (1995). “Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers”. Am. J. Gastroenterol. 90 (10): 1769–70. PMID 7572891.
  3. ↑ Cappell MS, Davis M (2006). “Characterization of Bouveret’s syndrome: a comprehensive review of 128 cases”. Am. J. Gastroenterol. 101 (9): 2139–46. doi:10.1111/j.1572-0241.2006.00645.x. PMID 16817848.
  4. ↑ Dubois A, Price SF, Castell DO (1978). “Gastric retention in peptic ulcer disease. A reappraisal”. Am J Dig Dis. 23 (11): 993–7. PMID 717362.
  5. ↑ “Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines”. Retrieved 22 September 2012.
  6. ↑ Sugimachi K, Inokuchi K, Kuwano H, Ooiwa T (1984). “Acute gastritis clinically classified in accordance with data from both upper GI series and endoscopy”. Scand J Gastroenterol. 19 (1): 31–7. PMID 6710074.
  7. ↑ Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR (2007). “Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines”. J Hepatobiliary Pancreat Surg. 14 (1): 15–26. doi:10.1007/s00534-006-1152-y. PMC 2784509. PMID 17252293.
  8. ↑ Dellinger EP, Forsmark CE, Layer P, Lévy P, Maraví-Poma E, Petrov MS; et al. (2012). “Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation”. Ann Surg. 256 (6): 875–80. doi:10.1097/SLA.0b013e318256f778. PMID 22735715.
  9. ↑ Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG; et al. (2013). “Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus”. Gut. 62 (1): 102–11. doi:10.1136/gutjnl-2012-302779. PMID 23100216.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]