Differentiating Constipation vs Ileus vs obstipation vs Bowel obstruction

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Differentiating Constipation vs Ileus vs obstipation vs Bowel obstruction 


                                Fig.1 :  3D VRT

Small Bowel Ileus or Obstruction:

It can be a challenging task sometime to differentiate between ileus or obstruction in a post operative setting. As early adhesion can lead to bowel obstruction. 

Initial Investigation: Appropriate clinical history, Clinical examination, auscultation of bowel sounds, checking electrolyte imbalance and X-Ray abdomen remain the key in diagnosis and management. 

MDCT is an important examination as a problem solving tool & when specific disease management issues need to be addressed. 

It helps in revealing the site, level, and cause of obstruction. It can demonstrate threatening signs of bowel inviability


Terminology:

1. Constipation: Infrequent, incomplete or difficult defecation with passage of hard or dry feces  

2. Ileus: Failure of normal intestinal motility in the absence of mechanical obstruction (temporary disturbance of peristalsis " paralytic ileus")

           a. Small bowel ileus

            b. Toxic megacolon

            c. Ogilvie's Syndrome / colonic psudo-obstruction


                  Fig 2. Paralytic Ileus

3. Obstipation: Acute abdominal pain, ability to pass flatus, but cessation of small bowel movements

4. Mechanical bowel obstruction: Interruption of normal bowel peristalsis due to structural barrier

                 a Sub acute small bowel obstruction


              Fig. 3: Subacute obstruction due to post op early adhesion. Positive  
            oral contrast has slow transit and shows passage beyond the area of 
            narrowing (red arrow)

                 b. Complete small bowel obstruction



            Fig. 3: Acute small bowel obstruction (complete) due to adhesion .                   band. Red arrow is the point of transition. J is jejunum and IL is ileum               (collapsed)

            

                 c. Strangulation

                 d. Closed loop obstruction

                 e. Colonic obstruction with or without incompetent IC valve


5. Some of the most common causes of bowel obstruction:

1. Adhesion / Band

2. Hernia

3. Neoplasm

4. Tuberculosis / IBD 


Prepared by: Dr. Sharad Maheshwari

20.4.2023

Updated" 22.04.2023


References:

1. https://www.ncbi.nlm.nih.gov/books/NBK13786/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780141/

3. https://pubs.rsna.org/doi/10.1148/radiographics.21.3.g01ma03613

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