What is the treatment for ileus?

Treatment of Ileus

The treatment of ileus requires a multifaceted approach including intravenous fluid resuscitation, nasogastric decompression in cases of severe distention, correction of electrolyte imbalances, and early mobilization while avoiding medications that worsen intestinal motility. 1

Initial Management

• Administer isotonic intravenous fluids (lactated Ringer's or normal saline) to correct and prevent dehydration and electrolyte imbalances 2, 1
• Place nasogastric tube for decompression in patients with severe abdominal distention, vomiting, or risk of aspiration 1, 3
• Continue intravenous rehydration until vital signs normalize and ileus resolves 1
• Correct electrolyte abnormalities, particularly potassium, which can affect intestinal motility 1, 3
• Subcutaneous heparin should be administered to reduce the risk of thromboembolism in patients with prolonged immobility 2

Supportive Care

• Maintain nil per os (NPO) status initially until bowel function returns 1, 3
• Provide nutritional support if ileus is prolonged:
  • Enteral nutrition is preferred when possible 2
  • Consider parenteral nutrition if enteral feeding is not tolerated or ileus is prolonged 2, 1
• Early mobilization to help stimulate bowel function and prevent complications of prolonged bed rest 2, 4
• Avoid fluid overloading as it can worsen intestinal edema and prolong ileus 2, 1

Pharmacologic Interventions

• Consider alvimopan (μ-opioid receptor antagonist) to accelerate gastrointestinal recovery when opioid analgesia is necessary 1
• Metoclopramide may be used to stimulate gastric emptying and intestinal transit, though its FDA approval is not specifically for ileus 5
• Oral magnesium oxide may promote bowel function once oral intake is resumed 1
• Avoid medications that can worsen ileus:
  • Anticholinergics
  • Opioids
  • Antidiarrheal agents 1, 3

Special Considerations

Postoperative Ileus

• Implement opioid-sparing analgesia strategies 2, 1
• Consider mid-thoracic epidural analgesia which is highly effective at preventing postoperative ileus 1
• Early removal of nasogastric tubes as routine nasogastric decompression may prolong ileus 2, 1
• Chewing gum may help stimulate bowel function through cephalic-vagal stimulation 2, 1

Ileus with Underlying Infection

• For ileus associated with Clostridium difficile infection, administer appropriate antimicrobial therapy 2, 1
• When oral administration is not possible due to ileus, intravenous metronidazole can be used for C. difficile infection 2

Mechanical vs. Functional Ileus

• Distinguish between mechanical and functional ileus as management differs 4
• Mechanical ileus often requires surgical intervention, while functional ileus typically responds to conservative management 4, 6
• Surgery should be performed if complete obstruction or strangulation is suspected 6

Monitoring and Follow-up

• Monitor for signs of bowel function return:
  • Passage of flatus
  • Bowel sounds
  • Reduction in abdominal distention 1, 4
• Resume oral intake gradually once bowel function returns, starting with clear liquids and advancing as tolerated 1
• Monitor for complications such as increased intra-abdominal pressure, which may lead to abdominal compartment syndrome requiring surgical decompression 3

Prevention Strategies

• Minimize opioid use for pain control 2, 1
• Prefer laparoscopic over open surgical approaches when surgery is necessary 1
• Early mobilization after surgery or illness 2
• Maintain proper fluid balance without overload 2, 1