From the Guidelines
An ileus is a temporary disruption of normal intestinal motility that prevents the passage of intestinal contents, often caused by abdominal surgery, electrolyte imbalances, certain medications, infections, or inflammatory conditions. It occurs when the normal coordinated contractions of the intestines slow down or stop completely, leading to a functional bowel obstruction without any physical blockage. Symptoms typically include abdominal distension, nausea, vomiting, inability to pass gas or stool, and abdominal pain. Ileus commonly develops after abdominal surgery, but can also result from other factors. Treatment generally involves bowel rest (nothing by mouth), intravenous fluids, correction of any underlying electrolyte abnormalities, and sometimes nasogastric tube placement to decompress the stomach. Medications that slow gut motility should be discontinued if possible. Most cases resolve with conservative management within 2-3 days, though prolonged ileus may require additional interventions. The condition occurs because inflammation, surgical manipulation, or metabolic disturbances interfere with the complex nervous system that coordinates intestinal muscle contractions, temporarily paralyzing sections of the bowel 1.
Causes and Risk Factors
- Abdominal surgery
- Electrolyte imbalances
- Certain medications (particularly opioids) 1
- Infections
- Inflammatory conditions affecting the abdomen
- Postoperative pain management, especially with opioids, can contribute to the development of ileus 1
Prevention and Management
- A multifaceted approach to minimizing postoperative ileus, including minimally invasive surgery, optimized fluid management, opioid-sparing analgesia, early mobilization, early postoperative food intake, laxative administration, and omission/early removal of nasogastric intubation should be used 1
- Early mobilization and oral intake can help prevent ileus 1
- Thoracic epidural analgesia (TEA) may reduce the incidence of paralytic ileus and improve intestinal blood flow 1
- Patient-controlled analgesia (PCA) can provide superior postoperative pain control and patient satisfaction, reducing the need for opioids 1
Treatment
- Bowel rest (nothing by mouth)
- Intravenous fluids
- Correction of any underlying electrolyte abnormalities
- Nasogastric tube placement to decompress the stomach
- Discontinuation of medications that slow gut motility if possible
- Early oral intake and mobilization to prevent prolonged ileus 1
From the Research
Definition of Ileus
- Ileus is a common challenge in adult surgical patients, with an estimated incidence of 17% to 80% 2
- It is characterized by decreased gastrointestinal myoelectric activity and motility, causing functional obstruction of intestinal transit without mechanical obstruction 3
- Ileus usually arises from an exaggerated intestinal reaction to abdominal surgery, often exacerbated by numerous other conditions 3
Causes of Ileus
- The main mechanisms of postoperative ileus pathophysiology include fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation 2
- Ileus can also be induced by metabolic disorders, drugs that inhibit intestinal motility, severe illnesses, and extensive surgery 3
- Methamphetamine intoxication can also induce ileus, especially in higher doses 4
Management of Ileus
- Management includes addressing the underlying cause and supportive care, such as intravenous rehydration, correction of electrolyte abnormalities, and discontinuation of antikinetic drugs 3
- Specific therapies for colonic pseudo-obstruction include neostigmine for pharmacologic colonic decompression and colonoscopic decompression 3
- Early enteral nutrition (EEN) has been shown to facilitate return of normal bowel function, achieve enteral nutrition goals, and reduce hospital length of stay in patients with ileus 2
- Metoclopramide has been studied as a potential treatment for ileus, but its effectiveness is uncertain, with some studies showing no significant benefit 5, 6