Intestinal Obstruction

Postoperative Ileus

Ambulatory Care,Gastrointestinal

Written by the doctors and editors at UpToDate
What is a postoperative ileus? — An ileus is a condition in which the intestine doesn't work normally (figure 1). Normally, the intestine's muscles squeeze to move air, fluid, and food through it. But in an ileus, the intestine has trouble moving the air, fluid, and food along in an organized way. These things then get stuck in the intestine and cause symptoms. A postoperative ileus is when an ileus happens after surgery. It can happen in children or adults.
What causes a postoperative ileus? — Different things can cause a postoperative ileus, including:
A long, major, or complicated surgery in the belly or pelvis area
A collection of blood in the belly or tissue in the region behind the intestines called the "retroperitoneum"
Certain medicines, especially strong pain medicines
Infection, such as infections of the intestine or inside of the belly
Not enough blood flow to the intestines
What are the symptoms of an ileus? — The most common symptoms are:
Belly pain
Belly swelling and bloating
Nausea and vomiting
Not being able to have a bowel movement or pass gas
Will I need tests? — Probably. Your doctor or nurse will ask about your symptoms and do an exam. To find out what's causing your ileus, he or she will probably do blood tests and imaging tests. Imaging tests create pictures of the inside of the body.
The imaging tests can include an X-ray, CT scan, or a series of X-rays called a "GI series." For the CT scan and GI series, you will drink a liquid called "contrast" beforehand. The contrast will show up on the CT scan or X-rays.
How is a postoperative ileus treated? — Treatment depends on your symptoms and what's causing your ileus. All people with an ileus are treated in the hospital.
To treat your symptoms and help you feel better, your doctor can:
Give you fluids and nutrition through a thin tube that goes into a vein, called an "IV"
Put a thin tube called a "nasogastric tube" in your nose, down your esophagus, and into your stomach – The tube can suck up the fluid and air in your stomach. This will make your stomach feel better and help keep you from vomiting.
Give you medicine to help your intestine start working normally again
Most people with a postoperative ileus get better in a few days. Chewing gum and getting out of bed to walk might help you get better faster.
If a medicine caused your ileus, your doctor will stop that medicine. He or she will also treat any other condition causing your ileus, if the condition can be treated.
People with an ileus do not usually need surgery. But they might if their problem is really because the intestines are blocked.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 16945 Version 5.0
Release: 28.2.2 - C28.105
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