Ileus natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
[[patient|Patients]] with [[ileus]] are usually presented with [[abdominal pain]], [[abdominal distention]], [[abdomen|abdominal]] [[cramp|cramping]], [[nausea and vomiting]] with [[postprandial]] discomfort, [[constipation]] or obstination and loss of appetite. Common [[Complication (medicine)|complications]] of [[ileus]] include [[Electrolyte imbalance|electrolyte imbalance]], [[malabsorption]], [[dehydration]], [[intestinal perforation]], [[Renal insufficiency|renal failure]], [[ascites]], [[sepsis]], [[jaundice]], [[intestine|Intestinal]] strangulation and [[pulmonary]] [[Complication (medicine)|complications]]. Depending on the duration of the [[ileus|postoperative ileus]] at the time of [[diagnosis]], the [[prognosis]] may vary. However, the [[prognosis]] is generally regarded as good. Most cases of [[ileus|postoperative ileus]] resolve spontaneously and do not require any further [[treatment]]. | |||
==Natural History== | ==Natural History== | ||
*[[patient|Patients]] with [[ileus]] are usually presented with:<ref name="pmid28439845">{{cite journal |vauthors=Rami Reddy SR, Cappell MS |title=A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction |journal=Curr Gastroenterol Rep |volume=19 |issue=6 |pages=28 |year=2017 |pmid=28439845 |doi=10.1007/s11894-017-0566-9 |url=}}</ref><ref name="pmid19399212">{{cite journal |vauthors=Zeinali F, Stulberg JJ, Delaney CP |title=Pharmacological management of postoperative ileus |journal=Can J Surg |volume=52 |issue=2 |pages=153–7 |year=2009 |pmid=19399212 |pmc=2663489 |doi= |url=}}</ref><ref name="pmid25917235">{{cite journal| author=Daniels AH, Ritterman SA, Rubin LE| title=Paralytic ileus in the orthopaedic patient. | journal=J Am Acad Orthop Surg | year= 2015 | volume= 23 | issue= 6 | pages= 365-72 | pmid=25917235 | doi=10.5435/JAAOS-D-14-00162 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25917235 }} </ref><ref name="pmid12578422">{{cite journal| author=Luckey A, Livingston E, Taché Y| title=Mechanisms and treatment of postoperative ileus. | journal=Arch Surg | year= 2003 | volume= 138 | issue= 2 | pages= 206-14 | pmid=12578422 | doi=10.1001/archsurg.138.2.206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12578422 }} </ref> | |||
*Depending | **[[Abdominal pain]], [[Cramp|cramping]] and discomfort | ||
*In postoperative ileus, some patients may have | **[[Abdominal distension]] | ||
*In patients | **[[Nausea and vomiting]] and [[postprandial]] discomfort. | ||
*Patients with [[sepsis]] and [[intestinal perforation]] require urgent medical attention and intervention. If untreated, severe ileus may be fatal. | **[[Constipation]] or obstination | ||
**Loss of appetite | |||
*Depending on duration and [[etiology]] of [[ileus]] ([[surgery]] or [[drugs]]), [[symptoms]] may range in severity from mild to severe. | |||
*In [[ileus|postoperative ileus]], some [[patient|patients]] may have [[symptom]] resolution within 1-2 days of [[surgery]]. | |||
*In [[patient|patients]] with no [[symptom]] resolution within 1-2 days after [[surgery]], development of more severe [[symptoms]], such as complete cessation of [[intestinal]] [[motility]], [[malabsorption]], [[sepsis]] and [[intestinal perforation]] could be seen. | |||
*[[patient|Patients]] with [[sepsis]] and [[intestinal perforation]] require urgent medical attention and intervention. If left untreated, severe [[ileus]] may be fatal. | |||
==Complications== | ==Complications== | ||
Complications | [[Complication (medicine)|Complications]] of [[ileus]] include:<ref name="pmid18090881">{{cite journal |vauthors=Stewart D, Waxman K |title=Management of postoperative ileus |journal=Am J Ther |volume=14 |issue=6 |pages=561–6 |year=2007 |pmid=18090881 |doi=10.1097/MJT.0b013e31804bdf54 |url=}}</ref><ref name="pmid28818187">{{cite journal |vauthors=Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC |title=Ileus in Adults |journal=Dtsch Arztebl Int |volume=114 |issue=29-30 |pages=508–518 |date=July 2017 |pmid=28818187 |pmc=5569564 |doi=10.3238/arztebl.2017.0508 |url=}}</ref><ref name="pmid5922468">{{cite journal |vauthors=Larmi TK |title=Mechanical ileus and malabsorption. A follow-up study |journal=Acta Chir Scand |volume=131 |issue=1 |pages=145–53 |date=1966 |pmid=5922468 |doi= |url=}}</ref><ref name="pmid26843914">{{cite journal |vauthors=Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL |title=Gallstone ileus, clinical presentation, diagnostic and treatment approach |journal=World J Gastrointest Surg |volume=8 |issue=1 |pages=65–76 |date=January 2016 |pmid=26843914 |pmc=4724589 |doi=10.4240/wjgs.v8.i1.65 |url=}}</ref><ref name="pmid12838002">{{cite journal |vauthors=Díte P, Lata J, Novotný I |title=Intestinal obstruction and perforation--the role of the gastroenterologist |journal=Dig Dis |volume=21 |issue=1 |pages=63–7 |date=2003 |pmid=12838002 |doi=10.1159/000071341 |url=}}</ref><ref name="pmid26288731">{{cite journal |vauthors=Ferguson HJ, Ferguson CI, Speakman J, Ismail T |title=Management of intestinal obstruction in advanced malignancy |journal=Ann Med Surg (Lond) |volume=4 |issue=3 |pages=264–70 |date=September 2015 |pmid=26288731 |pmc=4539185 |doi=10.1016/j.amsu.2015.07.018 |url=}}</ref><ref name="pmid11753040">{{cite journal |vauthors=Schwarz NT, Beer-Stolz D, Simmons RL, Bauer AJ |title=Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis |journal=Ann. Surg. |volume=235 |issue=1 |pages=31–40 |date=January 2002 |pmid=11753040 |pmc=1422393 |doi= |url=}}</ref><ref name="pmid26155282">{{cite journal |vauthors=Lee HG, Hwang S, Joo YH, Cho YJ, Choi K |title=Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report |journal=Korean J Hepatobiliary Pancreat Surg |volume=19 |issue=2 |pages=78–81 |date=May 2015 |pmid=26155282 |pmc=4494082 |doi=10.14701/kjhbps.2015.19.2.78 |url=}}</ref><ref name="pmid5129183">{{cite journal |vauthors=Valman HB, France NE, Wallis PG |title=Prolonged neonatal jaundice in cystic fibrosis |journal=Arch. Dis. Child. |volume=46 |issue=250 |pages=805–9 |date=December 1971 |pmid=5129183 |pmc=1647904 |doi= |url=}}</ref><ref name="pmid9521973">{{cite journal |vauthors=Fuchs JR, Langer JC |title=Long-term outcome after neonatal meconium obstruction |journal=Pediatrics |volume=101 |issue=4 |pages=E7 |date=April 1998 |pmid=9521973 |doi= |url=}}</ref> | ||
* [[Electrolyte imbalance]] | * [[Electrolyte imbalance]] | ||
* [[Renal insufficiency|Renal failure]] | |||
* [[Malabsorption]] | * [[Malabsorption]] | ||
* [[Dehydration]] | * [[Dehydration]] | ||
| Line 23: | Line 29: | ||
* [[Sepsis]] | * [[Sepsis]] | ||
* [[Jaundice]] | * [[Jaundice]] | ||
* [[Pulmonary]] complications | * [[Pulmonary]] [[Complication (medicine)|complications]] | ||
* [[intestine|Intestinal]] strangulation | |||
==Prognosis== | ==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.<ref name="pmid8813170">{{cite journal |vauthors=Choi J, O'Connell TX |title=Safe and effective early postoperative feeding and hospital discharge after open colon resection |journal=Am Surg |volume=62 |issue=10 |pages=853–6 |year=1996 |pmid=8813170 |doi= |url=}}</ref><ref name="pmid12678131">{{cite journal |vauthors=Burd RS, Cartwright JA, Klein MD |title=Factors associated with the resolution of postoperative ileus in newborn infants |journal=Int. J. Surg. Investig. |volume=2 |issue=6 |pages=499–502 |year=2001 |pmid=12678131 |doi= |url=}}</ref><ref name="pmid25917235">{{cite journal |vauthors=Daniels AH, Ritterman SA, Rubin LE |title=Paralytic ileus in the orthopaedic patient |journal=J Am Acad Orthop Surg |volume=23 |issue=6 |pages=365–72 |year=2015 |pmid=25917235 |doi=10.5435/JAAOS-D-14-00162 |url=}}</ref> | *Depending on the duration of the [[ileus|postoperative ileus]] at the time of [[diagnosis]], the [[prognosis]] may vary. However, the [[prognosis]] is generally regarded as good.<ref name="pmid8813170">{{cite journal |vauthors=Choi J, O'Connell TX |title=Safe and effective early postoperative feeding and hospital discharge after open colon resection |journal=Am Surg |volume=62 |issue=10 |pages=853–6 |year=1996 |pmid=8813170 |doi= |url=}}</ref><ref name="pmid12678131">{{cite journal |vauthors=Burd RS, Cartwright JA, Klein MD |title=Factors associated with the resolution of postoperative ileus in newborn infants |journal=Int. J. Surg. Investig. |volume=2 |issue=6 |pages=499–502 |year=2001 |pmid=12678131 |doi= |url=}}</ref><ref name="pmid25917235">{{cite journal |vauthors=Daniels AH, Ritterman SA, Rubin LE |title=Paralytic ileus in the orthopaedic patient |journal=J Am Acad Orthop Surg |volume=23 |issue=6 |pages=365–72 |year=2015 |pmid=25917235 |doi=10.5435/JAAOS-D-14-00162 |url=}}</ref> | ||
*Most cases of postoperative ileus resolve spontaneously and do not require any further treatment. | *Most cases of [[ileus|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. | *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 [[Intestinal obstruction|mechanical obstruction]]. | *Prolonged [[ileus|postoperative ileus]] (> 7 days) requires close monitoring and evaluation for underlying [[Intestinal obstruction|mechanical obstruction]]. | ||
==References== | ==References== | ||
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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
Patients with ileus are usually presented with abdominal pain, abdominal distention, abdominal cramping, nausea and vomiting with postprandial discomfort, constipation or obstination and loss of appetite. Common complications of ileus include electrolyte imbalance, malabsorption, dehydration, intestinal perforation, renal failure, ascites, sepsis, jaundice, Intestinal strangulation 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
- Patients with ileus are usually presented with:[1][2][3][4]
- Abdominal pain, cramping and discomfort
- Abdominal distension
- Nausea and vomiting and postprandial discomfort.
- Constipation or obstination
- Loss of appetite
- Depending on duration and etiology of ileus (surgery or drugs), symptoms may range in severity from mild to severe.
- In postoperative ileus, some patients may have symptom resolution within 1-2 days of surgery.
- In patients with no symptom resolution within 1-2 days after surgery, development of more severe symptoms, such as complete cessation of intestinal motility, malabsorption, sepsis and intestinal perforation could be seen.
- Patients with sepsis and intestinal perforation require urgent medical attention and intervention. If left untreated, severe ileus may be fatal.
Complications
Complications of ileus include:[5][6][7][8][9][10][11][12][13][14]
- Electrolyte imbalance
- Renal failure
- Malabsorption
- Dehydration
- Intestinal perforation
- Ascites
- Sepsis
- Jaundice
- Pulmonary complications
- Intestinal strangulation
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.[15][16][3]
- 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.
- ↑ 3.0 3.1 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.
- ↑ Luckey A, Livingston E, Taché Y (2003). "Mechanisms and treatment of postoperative ileus". Arch Surg. 138 (2): 206–14. doi:10.1001/archsurg.138.2.206. PMID 12578422.
- ↑ 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.