Can abdominal distension and paralytic ileus occur in deep‑vein thrombosis (DVT) or pulmonary embolism (PE)?

Abdominal Distention and Ileus in DVT/PE

Abdominal distention and paralytic ileus are not recognized manifestations of DVT or PE in any major guideline or evidence base. These gastrointestinal symptoms are not part of the established clinical presentation of venous thromboembolism.

Standard Clinical Presentations of VTE

The well-established manifestations of PE and DVT are cardiopulmonary and vascular, not gastrointestinal 1:

Pulmonary Embolism Presents With:

• Acute dyspnea and chest pain 1
• Hemodynamic instability (shock, hypotension) in massive PE 1
• Right ventricular dysfunction with elevated pulmonary vascular resistance 1, 2
• Tachycardia, hypoxemia, and alveolar hyperventilation 1
• Sudden death in severe cases 1, 3

Deep Vein Thrombosis Presents With:

• Leg pain, swelling, and edema (when symptomatic) 1
• Approximately one-third of DVT cases are completely asymptomatic 4
• Warmth and tenderness in the affected limb 1

Why Abdominal Symptoms Should Prompt Alternative Diagnoses

If a patient presents with abdominal distention and ileus, you must actively search for other causes rather than attributing these to DVT/PE 1. The European Society of Cardiology guidelines emphasize that echocardiography and imaging in PE are useful for differential diagnosis of acute dyspnea, not abdominal symptoms 1.

Critical Differential Considerations:

When abdominal distention and ileus occur in a patient with known or suspected VTE, consider:

• Mesenteric venous thrombosis (a distinct entity from lower-limb DVT, involving abdominal veins) 1
• Bowel ischemia from arterial causes
• Intra-abdominal sepsis or infection 1
• Inflammatory bowel disease (which itself increases VTE risk but causes ileus independently) 1
• Medication effects (opioids used for PE-related pain can cause ileus)
• Post-operative complications in surgical patients who also have VTE risk 1

Important Clinical Pitfall

The presence of fever, leukocytosis, or systemic symptoms in VTE patients should trigger evaluation for concurrent infection or other pathology 4, 5. Fever occurs in only 7% of PE patients, and when present, infectious causes must be excluded 4. Similarly, marked leukocytosis warrants investigation for sepsis, malignancy, or inflammatory conditions rather than being attributed to VTE alone 5.

Anatomical Consideration:

While pelvic vein thrombosis can involve peri-prostatic and peri-uterine plexuses 1, and accounts for up to 77% of cases when identifiable 2, these do not cause ileus or abdominal distention as recognized clinical features 1.

Practical Approach

If your patient has confirmed DVT/PE plus new abdominal distention and ileus:

1. Do not assume the abdominal symptoms are from VTE 1
2. Obtain abdominal imaging (CT abdomen/pelvis) to evaluate for mesenteric thrombosis, bowel ischemia, or other intra-abdominal pathology
3. Assess for medication-related ileus (especially opioid analgesics)
4. Rule out infection with appropriate cultures and inflammatory markers 4, 5
5. Consider inflammatory or malignant causes, particularly since cancer is a major VTE risk factor and can independently cause both VTE and abdominal complications 1, 5