What is Postoperative Ileus?
Postoperative ileus is a condition where the digestive system slows down or stops working after surgery. People with this condition may not be able to consume food or drink normally and might also experience a swollen abdomen. This happens because the normal movement that carries food through the digestive system is interrupted, but there’s no physical blockage causing the problem.
It’s common for people to have some slowdown in their digestion after having abdominal surgery. Most of the time, this doesn’t cause serious issues. In fact, many surgeons consider it a normal part of the body’s reaction to the procedure.
However, if the condition persists, it can cause several significant problems, such as longer hospital stays, increased medical costs, and discomfort for the patient. It’s also believed that postoperative ileus costs around 750 million dollars a year in the USA alone. Another reason why it’s important to be aware of postoperative ileus is that it can mimic other serious complications like a blocked bowel and can delay recovery from surgery.
So, it’s critical to take steps to prevent and treat postoperative ileus appropriately to exclude any other possible complications. This can help speed up the recovery process and avoid unnecessary discomfort and costs.
What Causes Postoperative Ileus?
Ileus is a common issue that can happen after surgeries in the belly area. It is basically a slowdown, or stoppage, of your digestion or the movement of food through your intestines. However, it’s not entirely agreed upon when your digestive tract gets back to normal following surgery. Usually, the colon, which is the last part to start working again, recovers within about 3 days after the surgery.
If the slowness or the halt of digestive process continues longer than that, it’s often seen as a problem. While it’s traditionally thought that handling the organs during surgery is what leads to ileus, we don’t fully understand why some people experience it for longer periods. It’s challenging to predict who might have a prolonged bout of ileus after surgery, but we generally think it’s due to a mix of nervous system, inflammatory, and drug-related reasons.
Even though the causes of ileus after surgery have been researched thoroughly to try and prevent or treat it more effectively, the development of the condition seems to be influenced by a range of factors and there is no confirmed single cause. However, it seems to be more likely in patients who have one or more of the following conditions:
1. Discontinuity of the gastrointestinal tract (as in cases of part removal) or handling of the intestines during surgery
2. Use of anesthetic and pain-relieving drugs
3. Lack of movement
4. Imbalance of minerals in the body, especially low levels of potassium
5. Blood accumulation within the belly area
6. Severe infection or blood poisoning within the belly area
7. Long-term illnesses like diabetes
8. Inflammation in the belly area, like pancreatitis
9. Intense pain
10. Failure of heart and lung functions.
Risk Factors and Frequency for Postoperative Ileus
Almost everyone who has abdominal surgery experiences some degree of postoperative ileus, which is a temporary stoppage of the bowel’s ability to pass food. In fact, up to 25% of people who had planned abdominal surgery will develop postoperative ileus. Even though it’s less common, prolonged ileus is also seen regularly after surgeries within the abdomen. After colon and rectum surgery, the incidence rates of prolonged postoperative ileus range from 5% to 30%.
In theory, surgeries that involve a lot of handling of the intestines or large cuts are more likely to result in postoperative ileus than surgeries that are performed through a laparoscope (a small tube inserted through the abdominal wall) or surgeries that don’t involve much handling of the intestines, like removing the gallbladder.
Signs and Symptoms of Postoperative Ileus
Postoperative ileus, a common issue after surgery, primarily presents with delayed bowel movements or difficulty passing gas. People with this condition often experience symptoms such as:
- Abdominal distension or bloating
- Persistent, diffuse abdominal pain
- Nausea and vomiting
- Inability to pass gas
- Difficulty tolerating solid food
During a physical check, a healthcare professional might notice a swollen and drum-like sounding abdomen. The bowel sounds could be absent or slow. If there’s tenderness or a sharp pain when the doctor gently pushes and quickly releases on the abdomen, it could indicate a more serious issue that needs further investigation.
Testing for Postoperative Ileus
If you’ve had surgery and are experiencing a delay in bowel movements or gas, along with belly bloating and possible nausea or vomiting, you might have something called a postoperative ileus. This is a condition, diagnosed by your doctor, that often happens after surgery. It’s important, though, to rule out other causes of these symptoms, especially a mechanical bowel obstruction, which is a blockage in the intestines.
Postoperative ileus tends to develop slowly, while symptoms of a mechanical obstruction usually come on quickly and are more severe. To help tell the difference between the two, an X-Ray or computed tomography (CT) scans may be used. Signs of ileus include widespread air and fluid levels and bloating in the bowel, while a mechanical obstruction results in swelling in the sections of the bowel before the blockage point and a fall-off in size after it.
Assessing a suspected case of postoperative ileus isn’t just about diagnosing the condition. It’s also about looking for other conditions that could be causing similar symptoms and for factors that could’ve contributed to the development of the ileus. Some factors, like inflammation of the inner lining of the abdominal wall (peritonitis) or internal bleeding, require immediate treatment. Other things your doctor might consider are your biochemical profile, a review of your medications and their side effects, your physical activity levels, and any existing constipation issues you might have.
Treatment Options for Postoperative Ileus
Managing postoperative ileus, or the temporary stoppage of bowel movement after surgery, usually involves supportive care. This generally includes replacing fluids intravenously, replenishing electrolytes, getting the patient to move around early, and sometimes the use of a nasogastric tube. A nasogastric tube is a thin, flexible tube that is put through the nose, down the throat, and into the stomach to remove air or fluid. Although the use of nasogastric tubes can help to reduce symptoms like bloating and discomfort, there’s limited evidence to support its overall effectiveness.
After surgery, it’s important to carefully manage pain relief. This involves striking a perfect balance between relieving pain and avoiding medications, especially opioids, that might worsen the condition of the bowel. Non-opioid painkillers are recommended where possible. Making sure that the levels of electrolytes and other substances in the body are within the normal range is also an important aspect of supportive care.
One of the simplest yet most effective measures is to encourage the patient to move around as soon as possible after surgery. Regular check-ups should also be done to catch any signs of complications or missed problems early.
While research on different treatment measures to overcome ileus hasn’t produced any significant results, there has been some improvement observed in studies where patients chew gum. As such, chewing gum is sometimes used as a part of ileus management, but it’s not a common practice.
What else can Postoperative Ileus be?
Postoperative ileus, or a slowdown of the digestive tract after surgery, can be hard to diagnose because it shares symptoms with several other conditions. Even though it’s not an emergency situation, some conditions with similar symptoms might need immediate treatment. That’s why it’s crucial to distinguish between ileus and mechanical obstruction, a physical blockage in the digestive tract, both at the start and during the course of the condition.
Moreover, various other problems within the abdominal area can cause symptoms similar to those of ileus and need to be taken into consideration. These include:
- Ischemia – insufficient blood supply to the organs
- Abscess – pocket of pus caused by an infection
- Surgical complication – unintended adverse events following surgery
- Inflammation of the intra-abdominal organs like cholecystitis (inflammation of the gallbladder) or pancreatitis (inflammation of the pancreas).
What to expect with Postoperative Ileus
The outlook for patients after surgery is usually good as the condition causing the intestines to temporarily stop working, known as postoperative ileus, typically gets better within one to three days with supportive care, such as rest and fluids. However, if the condition persists for several days, or if symptoms continue to worsen despite treatment, further examinations and imaging tests might be needed.
Possible Complications When Diagnosed with Postoperative Ileus
Complications following postoperative ileus can extend a patient’s hospital stay and increase healthcare costs. Usually, postoperative ileus gets better in a few days. However, if it continues, many complications may occur. These can be the result of not being able to eat, changes in blood salt levels, malnutrition, and decreased patient happiness.
Potential Complications:
- Extended hospital stay
- Increased healthcare costs
- Changes in blood salt levels
- Malnutrition
- Decreased patient satisfaction
Preventing Postoperative Ileus
Postoperative ileus is a temporary loss of normal bowel function that typically occurs after abdominal surgery. While not much is known about the factors that could increase your risk of developing this condition, two things seem to play a role: the severity of the surgery and the type of pain medication given. Opting for less invasive laparoscopic (small-incision) procedures and avoiding pain relievers called opioids, when possible, are proven methods to decrease your chance of experiencing these bowel issues after surgery.
