On the fourth day after an open total abdominal hysterectomy, a patient has abdominal distension, hiccups, and vomiting of faintly faeculent fluid. The abdomen is diffusely tympanitic and silent on auscultation. Plain X-ray shows gas distributed throughout both small and large bowel, including the rectum. Which combination favours paralytic ileus over mechanical obstruction?

• A High-pitched tinkling sounds with visible peristalsis
• B Colicky central pain with absolute constipation
• C Diffuse distension with a silent abdomen and gas in the colon and rectum ✓
• D Localised tenderness with a palpable tender lump

Explanation

Paralytic ileus after laparotomy produces painless distension, a silent abdomen, and plain films showing gas throughout the entire gastrointestinal tract down to the rectum, reflecting universal gut paralysis rather than a single transition point. Mechanical obstruction instead gives colicky pain, exaggerated or tinkling bowel sounds, and gas accumulating proximally with a collapsed distal colon and rectum. Localised tenderness or a tender lump raises suspicion of strangulation or a collection rather than simple ileus.

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.