From the Guidelines
The management of an ileus should prioritize a multifaceted approach to minimize its occurrence and impact, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission or early removal of nasogastric intubation, as recommended by the most recent guidelines 1.
Key Components of Ileus Management
- Optimized fluid management: This is crucial to prevent dehydration and electrolyte imbalances that can exacerbate ileus 1.
- Opioid-sparing analgesia: Opioids can worsen ileus, so using alternative pain management strategies is important 1.
- Early mobilization: Encouraging patients to move as soon as possible after surgery can help stimulate bowel motility and reduce the risk of ileus 1.
- Early postoperative food intake: When feasible, early feeding can help stimulate gut function and reduce the duration of ileus 1.
- Laxative administration: May be considered to help manage constipation and prevent further bowel dysfunction 1.
- Nasogastric intubation omission or early removal: Reduces the risk of gastric stasis and aspiration, and can help in the management of ileus by minimizing interventions that can worsen gut dysfunction 1.
Additional Considerations
- Bowel rest and hydration: Initial management may involve nothing by mouth (NPO) status and intravenous fluids to maintain hydration and electrolyte balance.
- Pain management: Preferably using non-opioid analgesics to avoid exacerbating ileus.
- Electrolyte correction: Crucial for maintaining proper gut function and motility.
- Prokinetic agents: May be considered in select cases, though their use should be guided by the most recent evidence and patient-specific factors.
Monitoring and Follow-Up
- Regular assessment of the patient's condition, including bowel sounds, abdominal distension, and passage of gas or stool, is essential to monitor the resolution of ileus.
- Daily reevaluation of the need for interventions such as nasogastric tubes and urinary catheters can help minimize their use and associated complications 1.
From the Research
Management of Ileus
The management of ileus can be divided into several key areas, including:
- Diagnostic evaluation: determining the cause of the ileus, whether mechanical or functional, is crucial for proper treatment 2
- Treatment: this may involve supportive measures, such as fluid resuscitation and analgesia, or surgical intervention in some cases 2, 3
- Interdisciplinary collaboration: close collaboration between healthcare professionals is necessary for effective management of ileus 2
Conservative Management
Conservative management of ileus may involve:
- Bowel rest: avoiding oral intake to reduce the workload on the bowel 4
- Nasogastric decompression: although its use is not always necessary and may be associated with increased risk of pneumonia and respiratory failure 5
- Intravenous hydration: to prevent dehydration and maintain electrolyte balance 3
- Analgesia: to manage pain and discomfort 3
Surgical Management
Surgical management may be necessary in cases of:
- Mechanical ileus: where there is a physical obstruction in the bowel 2, 3
- Strangulation: where the blood supply to the bowel is compromised 3
- Failure of conservative management: where the ileus does not resolve with supportive measures 3
Prevention and Treatment of Postoperative Ileus
Prevention and treatment of postoperative ileus may involve:
- Early refeeding: introducing oral nutrition as soon as possible after surgery 4
- Gum chewing: to stimulate bowel motility 4
- Tube feeds: to provide nutrition and maintain bowel function 4
- Cholinesterase inhibitors: to stimulate bowel motility 6
- Bowel management protocols: to prevent constipation and promote regular bowel movements 6