From the Research
Treatment for colonic ileus in children typically involves supportive care while the bowel function returns to normal. Initial management includes bowel rest (nothing by mouth), intravenous fluids to maintain hydration and electrolyte balance, and nasogastric tube placement to decompress the stomach and prevent vomiting. Pain management with appropriate analgesics is important, but opioids should be avoided as they can worsen ileus. Mobilization and early ambulation should be encouraged as movement helps stimulate bowel function.
Key Considerations
- The underlying cause of the ileus must be identified and treated, whether it's postoperative, infection-related, or due to electrolyte imbalances.
- Most cases resolve within 2-3 days with conservative management.
- Surgery is rarely needed unless there's an underlying mechanical obstruction or if the ileus fails to resolve with medical management.
- Regular reassessment of abdominal distension, bowel sounds, and passage of flatus or stool is essential to monitor progress.
Medications
- Medications like metoclopramide (0.1-0.2 mg/kg/dose every 6 hours) or erythromycin (3-5 mg/kg/dose every 6 hours) may be used as prokinetic agents to stimulate intestinal motility.
- For persistent cases, neostigmine (0.01-0.02 mg/kg/dose) might be considered under careful monitoring. According to 1, the use of promotility agents such as metoclopramide and erythromycin is not recommended due to lack of evidence supporting their effectiveness. However, early enteral nutrition (EEN) has been shown to facilitate the return of normal bowel function and reduce hospital length of stay.
Surgical Intervention
- Surgery may be necessary in cases of mechanical obstruction or if the ileus fails to resolve with medical management.
- A study by 2 found that subtotal colectomy with end ileostomy (STC-I) is a safe and reasonable surgical approach for refractory inflammatory bowel disease-related colitis in children.
- Another study by 3 found that antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation. It's essential to note that the provided evidence does not directly address the treatment of colonic ileus in children. However, based on the available information and general medical knowledge, the recommended treatment approach prioritizes supportive care, identification and treatment of the underlying cause, and careful consideration of surgical intervention when necessary.