Ileus natural history, complications and prognosis: Difference between revisions
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
If left untreated, patients with ileus may progress to develop abdominal pain, abdominal distention, nausea and vomiting with postprandial discomfort. Common complications of ileus include electrolyte imbalance, malabsorption, dehydration, intestinal perforation, ascites, sepsis, jaundice, and pulmonary complications. Depending on the duration of the postoperative ileus at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. Most cases of postoperative ileus resolve spontaneously and do not require any further treatment.
Natural History
If left untreated, patients with ileus may progress to develop abdominal pain, abdominal distention, nausea and vomiting with postprandial discomfort.[1][2]
- Depending upon the duration and cause of ileus (surgery or drugs), these symptoms may range in severity from mild to severe.
- In postoperative ileus, some patients may have reversal of symptoms within 1-2 days of surgery.
- In patients where reversal of symptoms are not observed within 1-2 days of surgery, they may progress to develop more severe symptoms of ileus such as complete inhibition of intestinal motility, malabsorption with sepsis and intestinal perforation.
- Patients with sepsis and intestinal perforation require urgent medical attention and intervention. If untreated, severe ileus may be fatal.
Complications
Complications may include or may lead to:[3][4][5][6][7][8][9][10][11][12]
- Electrolyte imbalance
- Malabsorption
- Dehydration
- Intestinal perforation
- Ascites
- Sepsis
- Jaundice
- Pulmonary complications
Prognosis
Depending on the duration of the postoperative ileus at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.[13][14][15]
- Most cases of postoperative ileus resolve spontaneously and do not require any further treatment.
- In general, correction of electrolyte abnormalities, avoidance of opioids analgesics and hydration leads to rapid reversal of symptoms associated with ileus.
- Prolonged postoperative ileus (> 7 days) requires close monitoring and evaluation for underlying mechanical obstruction.
References
- ↑ Rami Reddy SR, Cappell MS (2017). "A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction". Curr Gastroenterol Rep. 19 (6): 28. doi:10.1007/s11894-017-0566-9. PMID 28439845.
- ↑ Zeinali F, Stulberg JJ, Delaney CP (2009). "Pharmacological management of postoperative ileus". Can J Surg. 52 (2): 153–7. PMC 2663489. PMID 19399212.
- ↑ Stewart D, Waxman K (2007). "Management of postoperative ileus". Am J Ther. 14 (6): 561–6. doi:10.1097/MJT.0b013e31804bdf54. PMID 18090881.
- ↑ Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC (July 2017). "Ileus in Adults". Dtsch Arztebl Int. 114 (29–30): 508–518. doi:10.3238/arztebl.2017.0508. PMC 5569564. PMID 28818187.
- ↑ Larmi TK (1966). "Mechanical ileus and malabsorption. A follow-up study". Acta Chir Scand. 131 (1): 145–53. PMID 5922468.
- ↑ Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL (January 2016). "Gallstone ileus, clinical presentation, diagnostic and treatment approach". World J Gastrointest Surg. 8 (1): 65–76. doi:10.4240/wjgs.v8.i1.65. PMC 4724589. PMID 26843914.
- ↑ Díte P, Lata J, Novotný I (2003). "Intestinal obstruction and perforation--the role of the gastroenterologist". Dig Dis. 21 (1): 63–7. doi:10.1159/000071341. PMID 12838002.
- ↑ Ferguson HJ, Ferguson CI, Speakman J, Ismail T (September 2015). "Management of intestinal obstruction in advanced malignancy". Ann Med Surg (Lond). 4 (3): 264–70. doi:10.1016/j.amsu.2015.07.018. PMC 4539185. PMID 26288731.
- ↑ Schwarz NT, Beer-Stolz D, Simmons RL, Bauer AJ (January 2002). "Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis". Ann. Surg. 235 (1): 31–40. PMC 1422393. PMID 11753040.
- ↑ Lee HG, Hwang S, Joo YH, Cho YJ, Choi K (May 2015). "Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report". Korean J Hepatobiliary Pancreat Surg. 19 (2): 78–81. doi:10.14701/kjhbps.2015.19.2.78. PMC 4494082. PMID 26155282.
- ↑ Valman HB, France NE, Wallis PG (December 1971). "Prolonged neonatal jaundice in cystic fibrosis". Arch. Dis. Child. 46 (250): 805–9. PMC 1647904. PMID 5129183.
- ↑ Fuchs JR, Langer JC (April 1998). "Long-term outcome after neonatal meconium obstruction". Pediatrics. 101 (4): E7. PMID 9521973.
- ↑ Choi J, O'Connell TX (1996). "Safe and effective early postoperative feeding and hospital discharge after open colon resection". Am Surg. 62 (10): 853–6. PMID 8813170.
- ↑ Burd RS, Cartwright JA, Klein MD (2001). "Factors associated with the resolution of postoperative ileus in newborn infants". Int. J. Surg. Investig. 2 (6): 499–502. PMID 12678131.
- ↑ Daniels AH, Ritterman SA, Rubin LE (2015). "Paralytic ileus in the orthopaedic patient". J Am Acad Orthop Surg. 23 (6): 365–72. doi:10.5435/JAAOS-D-14-00162. PMID 25917235.