On postoperative day 4 after hemiarthroplasty, a 78-year-old woman has abdominal distension, diffuse discomfort without colicky pain, and a completely silent abdomen. Radiograph shows gaseous distension of both small and large bowel with gas present down to the rectum. What is the most likely diagnosis?

• A Paralytic (adynamic) ileus ✓
• B Mechanical small bowel obstruction from adhesions
• C Sigmoid volvulus
• D Faecal impaction with pseudo-obstruction requiring neostigmine

Explanation

Paralytic ileus after laparotomy, pelvic surgery, or orthopaedic procedures produces painless distension, a silent abdomen, and gas throughout the gut including the rectum. Mechanical obstruction gives colicky pain, active bowel sounds, and a gasless distal colon beyond the transition point. Gas in the rectum plus absent colicky pain excludes mechanical obstruction and makes neostigmine inappropriate.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.