From the Guidelines
Yes, sepsis can cause ileus. Ileus, a temporary cessation of normal bowel motility, is a common complication of sepsis, as evidenced by the fact that volume depletion in febrile patients is worsened by poor fluid intake due to nausea and/or vomiting and in the presence of ileus induced by intra-abdominal inflammation 1. During sepsis, the body's inflammatory response releases cytokines and other inflammatory mediators that can directly impair intestinal smooth muscle function and disrupt the normal neural pathways controlling gut motility.
Some key points to consider in the management of sepsis-induced ileus include:
- Treating the underlying sepsis with appropriate antibiotics and source control
- Maintaining fluid and electrolyte balance
- Bowel rest
- Nasogastric decompression if needed
- Potential use of prokinetic agents, though evidence for their effectiveness is limited, as seen in the complexities of managing intra-abdominal infections 1.
It's crucial to recognize sepsis-induced ileus early, as it can lead to bacterial translocation across the compromised intestinal barrier, potentially worsening the septic state and creating a dangerous cycle of deterioration. The guidelines for the diagnosis and management of complicated intra-abdominal infection in adults and children emphasize the importance of prompt antimicrobial therapy in patients with septic shock, including those with intra-abdominal infection 1.
From the Research
Sepsis and Ileus
- Sepsis can cause ileus, as it leads to a systemic inflammatory response that affects the gastrointestinal tract, resulting in intestinal barrier dysfunction and ileus 2.
- The interplay between inflammation, immune system, and neuronal pathways in the gastrointestinal tract plays a crucial role in the development of ileus during sepsis 2.
- Bacterial translocation, which occurs due to intestinal barrier dysfunction, is also a key factor in the pathogenesis of sepsis and associated organ failure, including ileus 3.
Mechanisms of Sepsis-Induced Ileus
- The complex interplay between mast cells, residential macrophages, glial cells, neurons, and smooth muscle cells in the gastrointestinal wall contributes to the development of ileus during sepsis 2.
- The release of neuroactive substances such as nitric oxide, prostaglandins, cytokines, chemokines, growth factors, tryptases, and hormones also plays a role in the pathogenesis of sepsis-induced ileus 2.
- The cholinergic anti-inflammatory pathway and the endocannabinoid system may be potential therapeutic targets for the treatment of sepsis-induced ileus 2, 4.
Clinical Implications
- Sepsis-induced ileus is a significant contributor to morbidity and mortality in critically ill patients, and understanding its pathogenesis is crucial for the development of effective therapeutic strategies 5, 6.
- Novel therapeutic approaches, such as targeting the gut microbiome, the cholinergic anti-inflammatory pathway, and the endocannabinoid system, may hold promise for the treatment of sepsis-induced ileus 3, 4, 6.