Post-OP Ileus

Question 1

What is Post-OP ileus?

Answer 1

Deceleration or arrest in intestinal motility following surgery.

It is classified as a functional bowel obstruction.

Question 2

What can post-op ileus be a sign of? (Even if it is usually innocent)

Answer 2

Collection or anastomotic leak

Question 3

Risk factors

Answer 3

Increased age

Na+, K+ and Ca2+ derangement

Neurological disorders

Use of anti-cholinergic medication

Use of opioid medication

Pelvic surgery

Extensive intra-operative intestinal handling

Peritoneal contamination

Intestinal resection

Question 4

Clinical features

Answer 4

Failure to pass flatus or faeces

Sensation of bloating and distension

N+V

Abdo distension and absent bowel sounds might be heard

In mechanical obstruction tinkling bowel sounds might be present

Question 5

Investigations

Answer 5

Initial routine bloods with FBC and CRP, U&Es, Ca2+, PO43- and Mg2+

CT abdomen pelvis will confirm diagnosis and is also important to rule out any intra-abdominal collections or anastomotic leaks

Question 6

Management

Answer 6

NBM + strict fluid-balance chart

Daily bloods + electrolytes

Encourage mobilisation as tolerated

Reduce opiate analgesia

NG tube might be inserted

Question 7

Prophylaxis

Answer 7

Minimise intra-operative intestinal handling

Avoid fluid overload

Minimise opiate use

Encourage early mobilisation