Post-op Ileus

Question 1

What is post-operative ileus?

Answer 1

• Deceleration or arrest in intestinal motility following surgery
• Functional bowel obstruction
• Very common after abdo or pelvic ortho surgery

Question 2

What can post op ileus be?

Answer 2

• Innocent - no underlying cause, just post op
• Sign of other intra-abdominal pathology eg anastomotic leak, faeces irritate bowel and cause it to stop functioning

Question 3

RF for post op ileus - patient factors

Answer 3

• Increased age
• Electrolyte derangement
• Neurological disorders eg Dementia and Parkinsons
• Use of anticholinergic medications

Question 4

Surgical RF of post op ileus

Answer 4

• Use of opioids
• Extensive intra-operative intestinal handling
• Peritoneal contamination eg pus/faeces
• Intestinal resection

Question 5

Symptoms of post op ileus

Answer 5

• Failure to pass faeces or flatus
• Sensation of bloating/distension
• Nausea/vomitting (or high NG tube output)

Question 6

Examination findings in post-op ileus

Answer 6

• Abdominal distension
• Absent bowel sounds - in mechanical obstruction they will be tinkling

Question 7

Bedside and bloods for suspected post op ileus

Answer 7

• FBC
• CRP
• U&E (fluid shifts –> AKI),
• Other electrolytes inc Ca2+, PO4, Mg2+

Question 8

Imaging to confirm diagnosis of post op ileus

Answer 8

• CT scan abdomen and pelvis (often +oral contrast)
• Also will rule out any intra-abdominal collections or anastomic leak
• Often shows dilation of bowel with no evidence of mechanical obstruction

Question 9

Initial management of post op ileus - as long as no underlying pathology

Answer 9

• NBM
• Adequate IV fluids prescribed - strict fluid balance chart
• Insert NG tube - free drainage, regular aspirations
• Daily bloods inc electrolytes - monitor abnormal and AKI
• Encourgae mobilisation
• Reduce opiate analgesia

Question 10

What may need to be done for prolonged ileus

Answer 10

• Consider early total paraenteral nutrition to ensure optimal nutrition is maintained

Question 11

Prophylactic measures to try and prevent post op ileus

Answer 11

• Minimise intra-operative intestinal handling
• Avoid fluid overload - causing intestinal oedema
• Minimise opiate use
• Encourage early mobilisation