A 55-year-old woman undergoes elective cholecystectomy. On postoperative day 6 she has mild abdominal discomfo and bloating. She has received antibiotics, morphine for pain and metoclopramide for nausea. She has not passed flatus or stools since the surgery. On auscultation bowel sounds are hypoactive. The doctor on duty orders an abdominal x-ray for the same. What is the most possible cause for her symptoms?

Some degree of ileus is common after most abdominal surgeries 'However, ileus after 3-5 days is known as pathologic or prolonged postoperative ileus. The X-ray demonstrates dilated loops of bowel without an abrupt cut-off point or air-fluid levels thus going against mechanical small bowel obstruction such as by gallstone impaction or adhesions. Besides, mechanical obstruction gives rise to hyperactive (tinkling) bowel sounds whereas ileus has hypoactive bowel sounds.