Silent Abdomen Without Bowel Sounds

CLINICAL DIAGNOSTIC MANUAL

A silent abdomen without bowel sounds is a significant clinical finding that suggests a disruption in intestinal motility. The absence of bowel sounds, known as adynamic ileus, may indicate complete intestinal obstruction or severe intestinal dysfunction.

This finding requires urgent evaluation, as it can be associated with serious and potentially life-threatening conditions such as peritonitis or intestinal infarction.

Detailed clinical evaluation and appropriate diagnostic tests are essential to determine the underlying cause and guide immediate treatment.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Peritonitis	Severe abdominal pain, distension, fever, absence of bowel sounds, tenderness, and rebound	Clinical history, physical examination	Abdominal and Pelvic CT scan, blood tests (CBC, electrolytes), paracentesis with peritoneal fluid analysis
Intestinal Infarction	Intense abdominal pain, distension, absence of bowel sounds, gastrointestinal bleeding, fever	Clinical history, physical examination, elevated lactate levels	Abdominal and Pelvic CT scan, mesenteric angiography, exploratory laparotomy
Paralytic Ileus	Abdominal distension, absence of bowel sounds, nausea, vomiting	Clinical history, physical examination	Abdominal X-ray, Abdominal and Pelvic CT scan
Complete Intestinal Obstruction	Abdominal pain, distension, nausea, vomiting, absence of bowel sounds	Clinical history, physical examination	Abdominal X-ray, Abdominal and Pelvic CT scan, abdominal ultrasound
Abdominal Sepsis	Fever, tachycardia, hypotension, absence of bowel sounds, abdominal distension	Clinical history, physical examination, positive blood cultures	Abdominal and Pelvic CT scan, blood tests (CBC, lactate, cultures)
Abdominal Trauma	Abdominal pain, distension, absence of bowel sounds, signs of shock	Clinical history, physical examination, signs of external trauma	Abdominal and Pelvic CT scan, FAST ultrasound, chest and abdominal X-rays