Paralytic ileus after surgery is characterized by which of the following?

• A. Postoperative ileus with mechanical obstruction
• B. Hyperactive bowel sounds
• C. Absence of bowel sounds and no flatus or stool
• D. Rapid improvement with fluids and laxatives

Answer: (C)

Paralytic ileus after surgery is a temporary shutdown of intestinal movement caused by surgery-related disruption of smooth muscle activity and neural control, often worsened by anesthesia and opioid pain medications. The hallmark is generalized hypoactive or absent bowel sounds with no passage of gas or stool. There isn’t a physical blockage, so you don’t usually see the crampy, intermittent pains or an obvious obstructive pattern you’d expect with a mechanical blockage. Instead, the abdomen may be distended and nauseated, and flatus or stool are not produced. This differentiates it from a mechanical obstruction, where bowel sounds can be normal or high-pitched early on and there are signs like cramping and vomiting with a more specific blockage pattern on exam and imaging. Management is supportive: reduce opioids, promote ambulation and early feeding as tolerated, and decompress with a tube if distension or vomiting is severe. Paralytic ileus typically resolves over a few days as bowel motility returns.