Ileus overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Ileus is a disruption of the normal propulsive gastrointestinal motor activity from non-mechanical mechanisms.[1][2] Motility disorders that result from structural abnormalities are termed mechanical bowel obstruction. Some mechanical obstructions are misnomers, such as gallstone ileus and meconium ileus, and are not true examples of ileus by the classic definition. [3]
Historical Perspective
The word ileus has been derived from the Greek word "είλειν" which means to twist. In 1958, Robertson, Eddy, and Vosseler were the first to describe a case of adynamic ileus associated with cecal perforation.
Classification
There is no specific system for classification of postoperative ileus. However, based on etiology, postoperative ileus may be classified into drug induced ileus, metabolic and electrolyte abnormalities induced ileum, and systemic disorder induced ileus.
Pathophysiology
Causes
Ileus can be caused by both mechanical obstructions and non-mechanical obstructions.
Differentiating Ileus overview from Other Diseases
Ileus must be differentiated from other diseases that cause abdominal pain, constipation, nausea and vomiting such as small bowel obstruction, gastric outlet obstruction, gastroparesis, gastrointestinal perforation, acute cholecystitis, acute pancreatitis, chronic pancreatitis, liver abscess and spontaneous bacterial peritonitis.
Epidemiology and Demographics
Ileus is most commonly seen in patients undergoing surgical treatment. The incidence and prevalence of ileus varies with the type of surgery performed. Patients with large incisions are relatively at a higher risk of developing ileus as compared to patients undergoing minor surgical procedures with small incisions. The incidence of ileus in patients undergoing laparotomy is approximately 9000 per 100,000 cases worldwide. The prevalence of ileus is not precisely known. However, it is estimated that that around 10 percent of the people undergoing surgical procedures develop ileus lasting more than three days. Patients of all age groups may develop ileus but more commonly seen in elderly due to underlying comorbidities. There is no racial predilection for ileus and both men and women are affected equally.
Risk Factors
Common risk factors in the development of iuleus include increasing age, electrolyte abnormalities , previous history of abdominal surgery, prolonged abdominal or pelvic surgery (laprotomy of lower GI procedures), delayed enteral nutrition, use of preoperative albumin, postoperative deep venous thrombosis, and hypothyroidism. Less common risk factors include spinal cord injury (thoracic cord), obesity, and peripheral vascular disease.
Screening
There is insufficient evidence to recommend routine screening for ileus.
Natural History, Complications, and Prognosis
If left untreated, patients with ileus may progress to develop abdominal pain, abdominal distention, nausea and vomiting with postprandial discomfort. Common complication of ileus include electrolyte imbalance, malabsorption, dehydration, intestinal perforation, ascites, sepsis, jaundice, and pulmonary complications. Depending on the duration of the postoperative ileus at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. Most cases of postoperative ileus resolve spontaneously and do not require any further treatment.
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Nil per os (NPO or Nothing by Mouth) is mandatory in all cases. Nasogastric suction and parenteral feeds may be required until passage is restored. There are several options in the case of paralytic ileus. Most treatment is supportive. If caused by medication, the offending agent is discontinued or reduced. Bowel movements may be stimulated by prescribing lactulose, erythromycin or in severe cases, (Ogilvie's syndrome) neostigmine. If possible the underlying cause is corrected (e.g. replace electrolytes).
Surgery
Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms, or if there are signs of tissue death.
Prevention
Prevention depends on the cause. Treating conditions, such as tumors and hernias, that can lead to obstruction may reduce your risk of getting an obstruction. Some causes of obstruction cannot be prevented.
References
- ↑ Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. The biological basis of modern surgical practice. 17/e. Elsevier Saunders, 2004.
- ↑ Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci 1990;35:121.
- ↑ Feldman M, Friedman LS, Brandt LJ, Sleisenger MH. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. Intestinal Obstruction and Ileus. 8/e. Elsevier Saunders, 2006.