From the Research
Introduction to Ileus Management
Ileus is a common challenge in adult surgical patients, with a complex pathophysiology involving fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation 1. Management of ileus includes addressing the underlying cause and supportive care.
Medical Interventions for Ileus
Several medical interventions have been proposed for the treatment of ileus, including:
- Promotility agents such as metoclopramide and erythromycin, however, their effectiveness is uncertain 1
- Cholinesterase inhibitors, which may be safe and effective in treating constipation, but are poorly prescribed 2
- Prucalopride, a 5-HT4 receptor agonist, which has shown potential in treating postoperative ileus, but requires further investigation with multi-centre randomized controlled trials 3
Supportive Care for Ileus
Supportive care for ileus includes:
- Early enteral nutrition (EEN), which has been shown to facilitate return of normal bowel function, achieve enteral nutrition goals, and reduce hospital length of stay 1
- Bowel rest and total parenteral nutrition (TPN) in certain cases, such as small bowel obstruction with ileal stricture 4
- Correction of electrolyte abnormalities, which may adversely impact motility recovery 5
Prevention of Ileus
Prevention of ileus is crucial, and can be achieved through:
- Enhanced recovery after surgery (ERAS) protocols
- Laparoscopic approaches
- Bowel management protocols using osmotic laxatives, although their effectiveness is uncertain 2
Treatment of Underlying Causes
Treatment of underlying causes of ileus, such as:
- Infection, with appropriate antibiotics 4
- Inflammation, with anti-inflammatory medications
- Mechanical obstruction, with surgical intervention if necessary 4
Caveats and Considerations
It is essential to consider the following when managing ileus:
- The level of evidence for most treatments is low, and further research is needed to establish effective management strategies
- Individual patient factors, such as underlying medical conditions and medication use, must be taken into account when developing a treatment plan
- A multidisciplinary approach, involving surgeons, anesthesiologists, and other healthcare professionals, is often necessary to manage complex cases of ileus 4