What is the treatment for ileus?

Treatment for Ileus

The treatment for ileus requires a multifaceted approach including intravenous fluid resuscitation, nasogastric tube decompression, correction of electrolyte abnormalities, opioid-sparing analgesia, early mobilization, and gradual reintroduction of oral intake as bowel function returns. 1, 2, 3

Initial Management

• Administer isotonic intravenous fluids (lactated Ringer's or normal saline) to correct dehydration and prevent electrolyte imbalances 1
• Place a nasogastric tube for decompression only in patients with severe abdominal distention, vomiting, or risk of aspiration, and remove as early as possible 1, 2
• Correct electrolyte abnormalities, particularly potassium and magnesium, which significantly affect intestinal motility 3
• Maintain nil per os (NPO) status initially until signs of bowel function return 3
• Continue intravenous rehydration until pulse, perfusion, and mental status normalize, and there is no evidence of ileus 1

Pharmacologic Interventions

• Implement opioid-sparing analgesia strategies as opioids significantly worsen ileus 2, 3
• Consider mid-thoracic epidural analgesia for postoperative ileus as it is highly effective at preventing prolonged ileus compared to intravenous opioid analgesia 1, 2
• Avoid medications that can worsen ileus, such as anticholinergics and opioids 3
• Consider alvimopan (μ-opioid receptor antagonist) to accelerate gastrointestinal recovery when opioid analgesia is necessary 1
• Oral magnesium oxide and bisacodyl (10-15 mg daily to TID) may promote bowel function once oral intake is resumed 4, 2
• Metoclopramide may be considered as a prokinetic agent (10-20 mg PO QID) for persistent ileus, though caution is advised in patients with hypertension 4, 5

Supportive Care and Nutrition

• If enteral feeding is contraindicated due to prolonged ileus, early parenteral nutrition is indicated 4
• Resume oral intake gradually once bowel function returns, starting with clear liquids and advancing as tolerated 1
• Chewing gum can help stimulate bowel function through cephalic-vagal stimulation 1, 2
• Early mobilization is crucial to stimulate bowel function and prevent complications of prolonged bed rest 4, 2
• Avoid fluid overloading as it can worsen intestinal edema and prolong ileus 2, 3

Special Considerations

• For postoperative ileus, implement a multifaceted approach 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 4, 2
• In cases of ileus associated with Clostridium difficile infection, specific antimicrobial therapy is required 1
• For bacterial overgrowth contributing to ileus, consider antibiotics such as rifaximin, amoxicillin-clavulanic acid, metronidazole, or ciprofloxacin 4
• For opioid-induced constipation contributing to ileus, consider methylnaltrexone (0.15 mg/kg subcutaneously every other day) 4

Monitoring and Follow-up

• Monitor for signs of bowel function return, including passage of flatus, bowel sounds, and reduction in abdominal distention 3
• For persistent ileus, consider water-soluble contrast agents or neostigmine as rescue therapy 2
• If symptoms worsen or fail to improve with conservative management, reevaluate for mechanical obstruction or other complications 3
• Early enteral nutrition has been shown to facilitate return of normal bowel function, achieving nutrition goals, and reducing hospital length of stay 6

Prevention Strategies

• Prefer laparoscopic over open surgical approaches when surgery is necessary 1, 2
• Avoid routine use of nasogastric tubes as they may prolong ileus 2, 3
• Maintain proper fluid balance without overload to prevent intestinal edema 2, 3
• Early removal of urinary catheters can facilitate mobilization 2