Post-operative ileus

Ileus is a condition which occurs from hypomotilitiy of the gastrointestinal tract in the absence of mechanical bowel obstruction. It is due to transient impairment in the propulsion of intestinal contents within the ileus which results in accumulation of gas and fluids in the bowel. The two most important aetiologies implicated in the development of ileus are inhibitory spinal reflex due to spinal anaesthesia used in major abdominal surgeries and inflammatory mediators released from the site of injury. Striking features of post-operative ileus are abdominal pain, distension, discomfort, nausea, vomiting, flatulence, belching and constipation. Characteristic sign of post-operative ileus is hypoactive or absent bowel sounds. Differential diagnosis is pseudo-obstruction/Ogilvie syndrome and mechanical bowel obstruction. Plain abdominal radiograph is the imaging modality helpful in diagnosing ileus. Management includes supportive treatment and correction of the underlying cause. Bowel movements may be stimulated by lactulose, erythromycin and neostigmine. Epidural blockade with local anaesthetics may prevent post-operative ileus. In summary management of ileus is a multivariate approach involving minimally invasive surgical procedures, opiate-sparing pain management and fast recovery protocols.