Postoperative Ileus Treatment & Management: Medical Care, Surgical Care, Diet

pj braun diet, postoperative ileus treatment

Postoperative Ileus Treatment & Management

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Medical Care

The management of ileus may vary greatly depending on the nature of the disease and the surgical procedure. Management of ileus starts with correction of underlying medical conditions, electrolyte abnormalities, and acid base abnormalities.

Most cases of postoperative ileus resolve with watchful waiting and supportive treatment. Patients should receive intravenous hydration. For patients with vomiting and distention, use of a nasogastric tube provides symptomatic relief; however, no studies in the literature support the use of nasogastric tubes to facilitate resolution of ileus. Long intestinal tubes have no benefit over nasogastric tubes. For postoperative patients receiving vasopressor support, limited data suggest that these patients can be safely initiated and advanced on enteral nutrition; clinicians must take into account the specific vasopressor agent, its dose and changes in regimen, as well as the patient’s clinical condition and characteristics. [29]

For patients with protracted ileus, mechanical obstruction must be excluded with contrast studies. Underlying sepsis and electrolyte abnormalities, particularly hypokalemia, hyponatremia, and hypomagnesemia, may worsen ileus. These contributing conditions are easily diagnosed and corrected.

Discontinue medications that produce ileus (eg, opiates). In one study, the amount of morphine administered directly correlated with the time elapsed before the return of bowel sounds and the passage of flatus and stool. [30]

The use of postoperative narcotics can be diminished by supplementation with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition to permitting lower narcotic doses by providing pain relief, NSAIDS may improve ileus by reducing local inflammation. An international multicenter prospective study is in progress to evaluate gastrointestinal recovery following colorectal surgery as well as to assess the role of NSAIDs in accelerating the return of gastrointestinal function. [1] Myoelectric activities recorded from electrodes placed on the colon have revealed faster resolution from ileus in patients given ketorolac versus those given morphine [31] ; however, the drawbacks of NSAID use include platelet dysfunction and gastric mucosal ulceration. Consider the use of a cyclooxygenase-2 selective agent (ie, celecoxib), which negates these adverse effects.

No single objective variable accurately predicts the resolution of ileus. The clinician must assess the overall status of the patient and evaluate for adequate oral intake and good bowel function. A patient’s report of flatus, bowel sounds, or stool passage may prove misleading; therefore, clinicians must not rely solely on self-reporting. Indeed, findings from a systematic review indicate that the best clinical endpoint of postoperative ileus is postoperative defecation in conjunction with solid food tolerance, whereas other clinical signs such as the presence of bowel sounds and the passage of flatus don’t appear to correlate with complete recovery of bowel motility. [24]

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