Post-Op Ileus

Question 1

What does a post-op ileum describe?

Answer 1

A deceleration or arrest in intestinal motility following surgery

Question 2

What is a post-op ileus classified as?

Answer 2

A functional bowel obstruction

Question 3

Is post-op ileus common?

Answer 3

Yes, very common

Question 4

When is post-op ileus particularly common?

Answer 4

After abdominal surgery or pelvic orthopaedic surgery

Question 5

Why is post-op ileus an important condition?

Answer 5

Although innocent in the majority of patients, it can be a sign of other intra-abdominal pathology, in particular a collection or anastomotic leak

Question 6

Why does an anastomotic leak lead to post-op ileus?

Answer 6

As pus or faeces will irritate the bowel and often cause it to cease functioning

Question 7

What is the problem with post-op ileus?

Answer 7

Shown to lengthen hospital stay and increased hospital costs

Question 8

What are the patient risk factors for post-op ileus?

Answer 8

• Increased age
• Electrolyte derangement
• Neurological disorders
• Use of anti-cholinergic medication

Question 9

What electrolyte derangements can increase the risk of post-op ileus?

Answer 9

Na, K, and Ca derangement

Question 10

What neurological conditions can increase the risk of post-op ileus?

Answer 10

• Dementia

- Parkinson’s disease

Question 11

What are the surgical risk factors for post-op ileus?

Answer 11

• Use of opioid medication
• Pelvic surgery
• Extensive intra-operative intestinal handling
• Peritoneal contamination
• Intestinal resection

Question 12

What are the presenting features of post-op ileus the same as?

Answer 12

Those of mechanical obstruction

Question 13

What are the presenting features of post-op ileus?

Answer 13

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

Question 14

What will be found on examination in post-op ileus?

Answer 14

• Abdominal distention

- Absent bowel sounds

Question 15

What is the aim of investigations in post-op ileus?

Answer 15

To rule out more serious pathologies and determine any underlying cause

Question 16

What investigations are done in post-op ileus?

Answer 16

• Initial routine bloods

- CT scan, often with oral contrast

Question 17

What initial routine bloods should be done in post-op ileus?

Answer 17

• FBC
• CRP
• U&Es
• Electrolytes

Question 18

Why should U&Es be checked in post-op ileus?

Answer 18

Fluid shifts can occur within the dynamic bowel leading to AKI

Question 19

What electrolytes should be checked in post-op ileus?

Answer 19

• Ca
• Phosphate
• Mg

Question 20

What is the purpose of CT scan in post-op ileus?

Answer 20

Confirm the diagnosis and rule out any collections/anastomotic leak

Question 21

What kind of management is used in post-op ileus?

Answer 21

As long as serious pathology, e.g. anastomotic leak, has been excluded, management is conservative

Question 22

How should any established post-op ileus be managed?

Answer 22

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

Question 23

What is it important to warn patients with post-op ileus about?

Answer 23

Once it does settle, they will get very watery diarrhoea for first 2-3 bowel movements

Question 24

What might some cases of post-op ileus warrant?

Answer 24

Insertion of NG tube on free drainage and catheterising with a fluid balance chart

Question 25

How can the risk of post-op ileus be reduced?

Answer 25

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