Postoperative ileus is a temporary slowdown of the digestive tract’s muscular contractions, known as peristalsis. This disruption is a common occurrence following surgical procedures, particularly those involving the abdomen. The condition is a functional issue, meaning the intestines are not working correctly, rather than being physically blocked.
Primary Causes and Risk Factors
The development of postoperative ileus is a result of the body’s response to the physical stress of surgery. The type and duration of the surgical procedure play a role, with abdominal or pelvic surgeries carrying a higher risk. Longer operations and open surgeries, as opposed to laparoscopic procedures, are also associated with an increased likelihood of developing an ileus.
Medications administered during and after surgery are contributing factors. Anesthetic agents can temporarily slow bowel function. Opioid pain medications, such as morphine and oxycodone, are prescribed for postoperative pain management and are known for their inhibitory effects on intestinal motility.
Electrolyte imbalances that can occur after surgery may also contribute to an ileus. Fluctuations in levels of electrolytes like potassium can interfere with the proper functioning of the smooth muscles of the intestinal walls. Certain pre-existing medical conditions, such as diabetes or a history of digestive disorders, can also increase a person’s susceptibility.
Signs and Symptoms of Postoperative Ileus
The signs of postoperative ileus are directly related to the accumulation of gas and fluids within the intestines. One of the most common complaints is a feeling of fullness or bloating in the abdomen, which may appear swollen. This can be accompanied by a loss of appetite and a sense of being full even without eating.
Nausea and vomiting are frequent symptoms, as the contents of the stomach and upper intestines are unable to move forward. In some cases, the vomited material may have a stool-like appearance. Another sign is the inability to pass gas or have a bowel movement, although some individuals may pass small amounts of watery stool. Vague abdominal pain or cramping can also occur.
Diagnosis and Treatment Protocols
Healthcare providers diagnose postoperative ileus through a physical examination and sometimes imaging studies. During the physical exam, a doctor or nurse will listen to the abdomen with a stethoscope to assess for bowel sounds. In cases of ileus, these sounds may be significantly reduced or absent.
To confirm the diagnosis and rule out a mechanical obstruction, which is a physical blockage, imaging tests such as an X-ray or a CT scan may be ordered. These images can reveal the presence of gas and fluid buildup in the intestines, as well as an enlarged appearance of the bowel, which are characteristic signs of an ileus.
The primary treatment is supportive care, aimed at allowing the intestines to rest and recover. This involves a period of “bowel rest,” where the patient is not allowed to eat or drink anything by mouth. To prevent dehydration and provide nutrients during this time, intravenous (IV) fluids are administered.
In some cases, a nasogastric (NG) tube may be inserted through the nose and into the stomach. This tube is connected to suction and helps to remove the contents of the stomach, relieving nausea, vomiting, and abdominal distension. Postoperative ileus resolves on its own within two to four days with these supportive measures.
Prevention and Recovery Enhancement
Several strategies can be employed to help prevent postoperative ileus or speed up recovery.
- Early mobilization, which involves getting out of bed and walking as soon as it is safe after surgery, helps stimulate the intestinal muscles.
- Modern pain management techniques, known as multimodal analgesia, reduce the reliance on opioid medications by using a combination of different types of pain relievers.
- Chewing gum is a simple method for stimulating the digestive system, as the act of chewing can trigger the release of hormones that promote intestinal motility.
- Careful management of IV fluids by the medical team during and after the surgical procedure helps maintain a proper fluid balance to support the digestive system.