From the Guidelines
The initial management for a patient presenting with subacute ileus pattern gaseous distention should begin with supportive treatment, including intravenous crystalloids, anti-emetics, and bowel rest, as soon as possible. This approach is crucial in managing the condition and preventing further complications. The use of isotonic dextrose-saline crystalloid and balanced isotonic crystalloid replacement fluids containing supplemental potassium is recommended, as it helps to replace lost fluids and electrolytes 1.
Key components of the initial management include:
- Intravenous fluid resuscitation with isotonic crystalloids to maintain hydration and electrolyte balance
- Bowel rest to reduce intestinal workload
- Anti-emetics to prevent vomiting and aspiration pneumonia
- Nasogastric suction, which can be both diagnostically useful and therapeutically important to prevent aspiration pneumonia and decompress the proximal bowel 1
- Insertion of a Foley catheter to monitor urine output, ensuring that the patient's fluid status and renal function are closely observed 1
By following this supportive care approach, patients with subacute ileus pattern gaseous distention can receive the necessary treatment to manage their condition effectively, focusing on reducing morbidity, mortality, and improving quality of life.
From the Research
Initial Management for Subacute Ileus Pattern Gaseous Distention
The initial management for a patient presenting with subacute ileus pattern gaseous distention involves several key steps:
- Correction of physiologic and electrolyte disturbances 2
- Bowel rest and removing the source of the obstruction 2
- Intravenous fluid resuscitation, analgesia, and determining need for operative vs. nonoperative therapy 3
- Nasogastric tube is useful for patients with significant distension and vomiting by removing contents proximal to the site of obstruction 3
Diagnosis and Treatment
Diagnosis typically requires imaging, and though plain radiographs are often ordered, they cannot exclude the diagnosis 3. Computed tomography and ultrasound are reliable diagnostic methods 3. Treatment includes medical resuscitation, such as intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction 4. Surgery is needed for strangulation and those that fail nonoperative therapy 3, 4.
Medication Management
Neostigmine is traditionally administered intravenously for treatment of acute colonic pseudo-obstruction (ACPO), though use is associated with administration constraints and adverse effects 5. Subcutaneous neostigmine may be reasonable for management of ileus, ACPO, or refractory constipation, though use should be avoided in patients with new-onset heart block, a history of second-degree heart block, or following bowel resection with primary anastomosis 5.
Patient Monitoring
Monitoring for bradycardia with telemetry may be considered when using subcutaneous neostigmine 5. Patients with signs of strangulation, such as fever, hypotension, diffuse abdominal pain, peritonitis, and several others, require close monitoring and potential surgical intervention 3.