From the Guidelines
Ileus can be life-threatening if not properly treated, as it may lead to severe complications such as bowel obstruction, perforation, sepsis, and even death. This condition, characterized by a lack of normal intestinal contractions, can lead to serious complications if left untreated. The severity depends on the underlying cause, duration, and whether complications develop. According to a study published in the Clinical Nutrition journal 1, prevention of postoperative ileus is a major cause of delayed discharge after abdominal surgery, and several interventions such as mid-thoracic epidural analgesia, avoidance of fluid overloading, and avoidance of nasogastric decompression have been successful in preventing postoperative ileus.
Some key points to consider in the management of ileus include:
- Addressing the underlying cause of ileus
- Bowel rest (nothing by mouth) to reduce the workload on the intestines
- Intravenous fluids for hydration to prevent dehydration and electrolyte imbalances
- Nasogastric tube placement to decompress the stomach and prevent vomiting
- Pain management to reduce the stress response and promote intestinal recovery
- In severe cases, surgery may be necessary to relieve obstruction or repair perforation
The life-threatening nature of ileus stems from potential complications like aspiration pneumonia from vomiting, electrolyte imbalances, bacterial overgrowth leading to infection, and intestinal ischemia or necrosis if blood flow is compromised. Prompt medical attention is essential when symptoms such as severe abdominal pain, persistent vomiting, abdominal distension, and inability to pass gas or stool occur, as early intervention significantly improves outcomes and reduces mortality risk. A more recent study published in the International Journal of Surgery 1 highlights the importance of accelerated recovery programs in reducing postoperative intestinal related complications, including ileus, after radical cystectomy. Therefore, it is crucial to prioritize prompt and proper treatment of ileus to prevent life-threatening complications and improve patient outcomes.
From the Research
Ileus Overview
- Ileus is a condition where the motor activity of the bowel is impaired, usually not associated with a mechanical cause 2.
- The term "ileus" originates from the Greek word for twisted, and its definition has changed over time to refer to nonmechanical obstruction that does not initially require operative treatment 3.
Life-Threatening Potential
- If prolonged and untreated, ileus can result in death, similar to acute mechanical obstruction 2.
- Postoperative ileus is a significant contributor to postoperative complications, increased length of stay, and increased healthcare costs 4, 5.
- Gallstone ileus, a rare disease, may result in a high mortality rate, especially in the elderly, and early diagnosis is crucial to reduce mortality 6.
Management and Treatment
- Management of paralytic ileus depends on the knowledge of the most likely cause and the perceived chance of resolution without operation 2.
- Early diagnosis and correct management are essential in reducing complications 2.
- The use of alvimopan, a peripheral μ-opioid receptor antagonist, has been shown to accelerate the return of gastrointestinal function postoperatively and reduce the incidence of postoperative ileus 4, 5.
- Surgery remains the mainstay of treatment for gallstone ileus, and early diagnosis is critical to improve outcomes 6.