From the Guidelines
Management of Ileus
The management of ileus should start with a multifaceted approach to minimize postoperative ileus, 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.
- Conservative treatment should include bowel rest, intravenous hydration, and correction of electrolyte imbalances.
- Nasogastric suction may be considered to decompress the stomach and intestines, but its use should be evaluated daily and removed as early as possible 1.
- Pharmacological treatment with metoclopramide or erythromycin can be used to stimulate bowel motility.
- Opioid-sparing analgesia and early mobilization are crucial in preventing opioid-induced ileus and promoting bowel recovery 1.
- Laxative administration, such as bisacodyl, can improve postoperative intestinal function 1.
- Monitoring for signs of bowel recovery, such as bowel sounds, passage of gas, and stool, is essential.
- Surgical intervention may be necessary in cases of mechanical obstruction or severe complications.
It is also important to note that mid-thoracic epidural analgesia and laparoscopic-assisted surgery can help prevent postoperative ileus 1. Additionally, oral magnesium oxide and chewing gum have been shown to promote postoperative bowel function 1.
Overall, a comprehensive approach to ileus management, including prevention, conservative treatment, and pharmacological intervention, can help improve patient outcomes and reduce the risk of complications.
From the Research
Management of Ileus
The management of ileus involves addressing the underlying cause and providing supportive care. According to 2, multiple medical interventions have been proposed, but their effectiveness is uncertain.
Medical Interventions
Some medical interventions that have been studied for the management of ileus include:
- Promotility agents such as metoclopramide and erythromycin, which were found to be ineffective in expediting the resolution of ileus 2
- Early enteral nutrition (EEN), which has been shown to facilitate the return of normal bowel function, achieve enteral nutrition goals, and reduce hospital length of stay 2
- Opioid receptor antagonists, such as alvimopan, which have been found to significantly shorten the duration of ileus 3
- Serotonin receptor agonists, which may also be effective in reducing postoperative ileus, although further studies are needed to confirm this 3
Non-Pharmacological Interventions
Non-pharmacological interventions that may be used to manage ileus include:
- Avoidance of preoperative fasting and mechanical bowel preparation 4
- Use of epidural-local anesthetics 4
- Implementation of minimally-invasive surgical techniques 4
- Modification of pain management strategies to limit opioid administration 4
- Conservative treatment, such as extracorporeal shock-wave lithotripsy, mechanical intestinal dilatation, and endoscopic removal of the gallstone, which may be effective in select patients with gallstone ileus 5
Supportive Care
Supportive care for patients with ileus may include:
- Fluid management to prevent dehydration and electrolyte imbalances
- Bowel rest to reduce the workload on the bowel
- Pain management to reduce discomfort and promote recovery
- Monitoring for complications, such as bowel ischemia or perforation
Treatment Duration
The duration of treatment for ileus may vary depending on the underlying cause and the patient's response to treatment. According to 6, a trial of conservative treatment for up to 5 days may be effective in resolving postoperative intestinal obstruction, while longer treatment durations may be ineffective.