Postoperative Ileus

1
Postoperative Ileus

• Quinisha Logan, M3

2

• Ileus
• Intestinal distention with slowing/absence of
  passage of luminal contents without a
  demonstrable mechanical obstruction
• Postoperataive ileus
• Transient impairment of bowel function and
  motility occurring after surgery

3
Clinical Features

• Nausea
• Vomiting
• Inability to eat
• Bowel distention
• Absence of flatus
• Absence of bowel movements

4
Etiology

• Thought to be secondary to trauma to the bowel
• Results in release of inflammatory mediators
• inflammatory mediators activate inhibitory neural
  reflexes that decrease GI motility
• Opioids add to the symptoms and duration of ileus
  
• Increase in uncordinated contractions of bowel so
  that there is increased tone but decrease bowel
  transit

5
Therapy

• Traditional
• NG tube
• Empties the stomach, decrease likelihood of
  aspiration
• IV fluids until pt tolerate po
• Mobilization
• Laxatives
• Prokinetic agents
• Cisapride serotonin receptor agonist increase
  levels of acetylcholine in myenteric plexus
• Removed from market because of increase incidence
  cardiac dysrhythmias
• Erythromycin motilin receptor agonist that act
  on proximal bowel
• Stimulates gastric emptying postoperative ileus

6
Therapy cont

• Laparoscopic surgery
• Faster recovery and shorter hospital stay
• NSAIDS
• Prevent inflammatory response which decrease
  inhibition of neural reflexes
• Cant be used for post-operative pain control
  alone
• Can lead to gastric ulceration and there are
  anti-platelet effects
• Epidural Thoracic Anesthesia

7
Conclusions

• Traditional therapy involves NG suction,
  mobilization, laxatives and prokinetic agents
• Prevention includes NSAIDS, Lap. Surgery and
  Epidural Thoracic Analgesics
• Studies have not demonstrate clinical benefits

8
References

• Townsend Sabiston Textbook of Surgery, 17th ed.
• Hocking, Michael A. Senagore Peter Stedman.
  Contemporary Perioperative Patient Care New
  Consideration in the Management of Postoperative
  Ileus and Perioperaive Pain