Post-op ileus

Question 1

What is post operative ileus?

Answer 1

Deceleration or arrest in intestinal motility (peristalsis) following surgery -leading to pseudo-obstruction, functional obstruction of the bowel.
Common
Can be a sign of intra-ado pathology , collection or anastomotic leak (as pus or faeces will irritate the bowela nd cause it to cease function

Increaseslenght of stay and costs

Question 2

What is the likely diagnosis of a patient who has a bowel obstruction failing to progress after a bowel resection?

Answer 2

Anastomotic leak

Question 3

What are risk factors for post-op ileus?

Answer 3

Patient factors:
Icnreased age
Electrolyte derangement 
Neurological disorders 
Anti-cholinergic medication

Surgical factors 
Use of opioid medication
Pelvic surgery
Extensive intra-operative intestinal handling
Peritoneal contamination (pus/faeces)
Intestinal resection

Question 4

What are the clinical features of post-op ileus?

Answer 4

Failure to pass flatus/faeces
Sensation of bloating and distention
Nausea and vomiting / high NG tube output

OE abdo distention, absent bowel sounds

Question 5

How does post-op ileus present differently to mechanical obstruction?

Answer 5

Bowel sounds tinkling in mechanical obstruction, absent in post-op ileus

Question 6

What investigations for post-op ileus?

Answer 6

Aim: rule out more serious pathology and find underlying cause
Initial bloods - FBC, CRP (to assess intra-abdominal collections or leaks) U&E and calcium levels 9electrolyte abnormality can cause paralytic ileus

CT scan will confirm diagnosis and rule out any collections/anastomotic leak

Question 7

What is management of post-op ileus?

Answer 7

Conservative if serious pathology is ruled out

Daily bloods including electrolytes
Encourage mobilisation
Reduce opiate analgesia and any other bowel mobility reducing medication

Warn patients once ileus settles they will get very watery diarrhoea for first 2-3 movements

NG tube
Catheterisation and fluid balance

Question 8

What are prophylactic measures to reduce risk of post op ileus?

Answer 8

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

Gum chewing post op