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Management of Postoperative Ileus

Mar 2010 – by P. DiSaia, MD

Ileus (intestinal paralysis) is most common following abdominal surgery. The pathophysiology of the condition is poorly understood. Atony of the stomach, colon and sometimes also the small bowel is the usual presentation and usually spontaneously resolves in a few days. In most cases the small bowel recovers first (within 24 hours) followed by the stomach and colon in 3-4 days.

The patient usually experiences abdominal distention, abdominal pain, nausea and/or vomiting. The hallmark of management is patient waiting for resolution with use of nasogastric decompression as necessary and intravenous hydration while the patient remains NPO. It is recommended that narcotic use be minimized and nonsteroidal anti-inflammatory drugs be used instead since narcotic drugs appear to prolong the process.

When ileus persists for an inordinate length of time (longer than 3-4 days) following surgery, the possibility of intestinal obstruction, possibly associated with an intra-abdominal abscess or another process, must be considered. An abdominal CT-scan obtained along with a small bowel contrast examination with barium will identify the bowel obstruction in a large percent of patients and may also identify an abscess, etc.

Intragastric administration of a water soluble contrast agent (e.g. gastrografin) has been shown to help in the resolution of paralytic ileus. In one study 120 ml of diatrizoate meglumine via nasogastric tube to adults with postoperative ileus restored postoperative ileus and intestinal motility within 6 hours allowing oral nutrition within 24 hours.