Small Bowel Surgery
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Ileus is defined as bowel dysmotility in the absence of a mechanical obstruction. It is usually a self-limiting process, but can produce significant morbidity and increase hospital length of stay and hospital cost. Ileus fall into two categories: expected postoperative ileus or paralytic ileus. Postoperative ileus (POI) is the uncomplicated ileus occurring following surgery, generally resolving spontaneously in about 2–3 days, while paralytic POI lasts longer than 3 days [1]. Risk factors for paralytic ileus include overuse of narcotics, retroperitoneal inflammation, sepsis, and spinal cord injury. Artinyan and colleagues examined the extent and duration of POI in 88 patients who underwent elective abdominal surgery. The duration of POI was 10 days or less in 96.6% of patients and the median duration was 5 days. The mean number of days to initiation of unrestricted clear liquids were 1.6% and 22.7% of patients were tolerating a solid diet by postoperative day (POD) 6. Variables within the patient population such as age, body mass index (BMI), anesthesia time, surgery time, estimated blood loss (EBL), and total opioid dose were examined to determine whether correlation exists to the duration of POI. Statistically, only EBL and total opioid dose were independently and significantly associated with duration of POI [2]. Symptoms of POI include increasing abdominal pain, distention, nausea and vomiting, and obstipation.
Postoperative care
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Paralytic ileus may present with nausea, vomiting, loss of appetite, bowel distension and absence of flatus or bowel movements. Following laparotomy, gastrointestinal motility temporarily decreases. Treatment is usually supportive, with maintenance of adequate hydration and electrolyte levels. However, intestinal complications may present as prolonged ileus and so should be actively sought and treated. Return of function of the intestine occurs in the following order: small bowel, large bowel and then stomach. This pattern allows the passage of faeces despite continuing lack of stomach emptying and, therefore, vomiting may continue even when the lower bowel has already started functioning normally.
Complications of Intestinal Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Violation of the peritoneum causes a cascade of physiologic events, some of which result in inhibition of gastrointestinal function. Physical manipulation of the viscera further impairs gut motility through splanchnic sympathetic reflex inhibition as well as through stimulation of local inflammatory mediators. Bowel motility commonly seen at laparotomy may not represent effective, coordinated peristalsis. Depending on the site and degree of visceral manipulation, the underlying disease process, and patient characteristics, paralytic ileus may last from hours to days. Postoperative ileus is further exacerbated by the use of opioids for analgesia. Traditionally, postoperative ileus has been treated with bowel rest, nasogastric suction, and early mobilization. Despite what we commonly tell our patients, early mobilization does not appear to hasten recovery from ileus; more likely, it is a marker for adequate postoperative pain control, which may decrease other postoperative complications. Nasogastric suction and early enteral feeding have been studied, with small, but statistically significant improvements in resolution of postoperative ileus associated with early resumption of enteral nutrition. The use of regional analgesic agents has also been shown to decrease the duration of postoperative ileus. The use of minimally invasive versus open surgical techniques appears to decrease the duration of postoperative ileus. To date, none of these studies have involved patients undergoing extensive small intestinal surgery. Patients undergoing extensive small bowel manipulation are at greatest risk for having prolonged postoperative ileus. Prolonged paralytic ileus in these patients may rightfully be considered an expected consequence of disease. Conversely, prolonged ileus in a patient who has undergone an elective colorectal procedure or gynecologic procedure may be considered a surgical complication, and appropriate perioperative care can decrease its duration.
Paralytic ileus in the patient with tuberculosis of spine
Published in British Journal of Neurosurgery, 2020
Viskasari P. Kalanjati, Rury T. Oktariza, Yahya Yahya, Abdulloh Machin
Background: We reported a patient with spinal tuberculosis and paralytic ileus. A 56-year-old Javanese male presented with lower limb paralysis and bowel obstruction 2 weeks prior to admission. He was found to have hypoalbuminemia and hypesthesia from the T7/T9 levels and below. Other than increased alanine aminotransferase, hematology and blood chemical tests were normal. MRI and plain abdominal radiographs confirmed the diagnosis of spinal tuberculosis at the T5/6 level and paralytic ileus. Tubercles in the lymphoid tissue of the intestinal submucosa were not seen. Conclusion: Paralytic ileus may occur in spinal TB.
Constipation, ileus and medication use during clozapine treatment in patients with schizophrenia in Iceland
Published in Nordic Journal of Psychiatry, 2018
Oddur Ingimarsson, James H. MacCabe, Engilbert Sigurdsson
Purpose of the article: Clozapine is the only evidence based treatment for treatment-resistant schizophrenia. Constipation is a well known side effect of clozapine treatment. The aims of this study are to describe the prevalence of constipation and ileus during clozapine treatment of patients with schizophrenia in Iceland and to assess the concomitant use of medication that can cause constipation, and laxatives used to treat constipation. Materials and methods: We identified 188 patients treated with clozapine by searching the electronic health records of Landspitali, the National University Hospital, during the study period 1.1.1998 – 21.11.2014. Cases of constipation and ileus were identified using an electronic search with keywords related to ileus in the patients’ electronic health records. Detailed medication use was available for 154 patients that used clozapine for at least one year. Results: Four out of 188 patients were diagnosed with ileus that resulted in admission to hospital. Two of these required a permanent stoma as a consequence of their ileus. Laxatives were prescribed for 24 out of 154 patients (15.4%) while on clozapine. In total 40.9% of the patients either had laxatives prescribed or had constipation documented in the medical records. Apart from clozapine, other medications known to cause constipation were prescribed to 28 out of 154 patients (18.2%). Conclusions: Constipation is a common problem during clozapine treatment which can progress to full-blown ileus which can be fatal. Clinicians need to monitor signs of constipation during treatment with clozapine and respond to it with lifestyle advice and laxative treatment.
Prucalopride for the treatment of ileus
Published in Expert Opinion on Investigational Drugs, 2017
Christopher J Smart, Kamran I Malik
Introduction: Postoperative ileus (POI) is an impairment of coordinated gastrointestinal (GI) motility that develops as a consequence of abdominal surgery and is a major factor contributing to patient morbidity and prolonged hospitalisation. Despite the availability of various options its treatment is still under debate. This review will focus on effect of Prucalopride (5-HT4 receptor agonist) on postoperative ileus based on the existing literature. Areas covered: A literature search of MEDLINE, EMBASE and COCHRANE Library was performed concerning topics related to the treatment of ileus with prucalopride. The search strategy also included articles relating to other treatments of ileus for comparison with prucalopride. Expert opinion: Postoperative ileus remains difficult to treat and most strategies encompass preventative measures through enhanced recovery after surgery and laparoscopic approaches. The role of pharmacological intervention is developing with some drugs licensed for use. The evidence for prucalopride remains unclear although there is randomised controlled trial (RCT) evidence available. Given the potential for reduction in patient morbidity and length of stay the role of prucalopride in POI should be further investigated with multi-centre RCTs to establish which group of patients will gain the most from this exciting potential treatment.
Related Knowledge Centers
- Anal Canal
- Gastrointestinal Tract
- Nervous System
- Smooth Muscle
- Peristalsis
- Intestinal Contents
- Intestinal Motility