From the Guidelines
Ileus is a temporary cessation of normal bowel motility that prevents the passage of intestinal contents, typically occurring after abdominal surgery, and can be minimized with a multifaceted approach including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation 1.
Definition and Causes
Ileus is characterized by the slowing down or complete stop of normal coordinated muscle contractions of the intestines, leading to symptoms such as abdominal distension, nausea, vomiting, inability to pass gas or stool, and abdominal pain. It can result from various factors including infections, electrolyte imbalances, medications (particularly opioids), or inflammatory processes in the abdomen.
Prevention and Management
Prevention of postoperative ileus is a key objective of enhanced-recovery protocols, and several interventions have been shown to be successful, including mid-thoracic epidural analgesia, avoidance of fluid overloading, and avoidance of nasogastric decompression 1. Laparoscopic-assisted colonic resection has also been demonstrated to lead to faster return of bowel function compared to open surgery 1. Additionally, oral magnesium oxide and bisacodyl have been shown to promote postoperative bowel function in some studies 1.
Treatment
Treatment of ileus usually involves bowel rest, intravenous fluids to maintain hydration, and addressing the underlying cause. Medications that stimulate bowel motility like metoclopramide or erythromycin may be used in some cases. Early ambulation after surgery and minimizing opioid use can also help prevent postoperative ileus.
Key Recommendations
- A multifaceted approach to minimizing postoperative ileus should be used, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation 1.
- Early mobilization should be assisted as soon as possible after surgery 1.
- Perioperative use of chewing gum has a positive effect on postoperative duration of ileus 1.
- Alvimopan, a μ-opioid receptor antagonist, can accelerate gastrointestinal recovery and reduce the length of stay in patients undergoing open colonic resection with postoperative opioid analgesia 1.
From the Research
Definition and Incidence of Ileus
- Ileus is a common challenge in adult surgical patients, with an estimated incidence of 17% to 80% 2.
- It is characterized by a temporary cessation of the normal contractions of the bowel muscles, leading to a build-up of food, fluids, and gas in the digestive tract.
Pathophysiology of Ileus
- The main mechanisms of postoperative ileus pathophysiology include fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation 2.
- Critical illness and its specific treatments, such as sepsis, multiorgan failure, sedation, and mechanical ventilation, can also contribute to the development of ileus 3.
Management and Treatment of Ileus
- Management of ileus includes addressing the underlying cause and supportive care, such as nasogastric suction and management of fluid and electrolyte imbalances 4.
- Prokinetic agents, such as metoclopramide, cisapride, and erythromycin, have been used to reduce the duration of postoperative ileus, but their efficacy is uncertain and may be limited by potential adverse effects 2, 5, 4.
- Early enteral nutrition (EEN) has been shown to facilitate the return of normal bowel function, achieve enteral nutrition goals, and reduce hospital length of stay in patients with ileus 2.
- Cholinesterase inhibitors and enteral opioid antagonists may be useful in the treatment of constipation and upper digestive intolerance in critically ill patients 3.
Prevention of Ileus
- Prevention of ileus may involve the use of bowel management protocols, including osmotic laxatives, although the effectiveness of these protocols is unclear 3.
- Avoiding high doses of opioids during sedation and using alternative pain management strategies may also help prevent ileus in critically ill patients 3.