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PubMed2005

Incidence of postoperative ileus after paraaortic lymph node dissection in patients with malignant gynecologic tumors.

BACKGROUND: Paraaortic lymph node metastasis is an important prognostic factor in gynecologic malignancy. However, paraaortic lymph node dissection (PAND) is not done routinely in Japan because of the difficulty of the procedure and the high incidence of complications. We performed PAND in 217 patients in a 7-year period. In the present study, we focused on the occurrence of postoperative ileus in patients who underwent PAND. METHODS: Two hundred and seventeen patients with malignant gynecologic tumors were operated on at our hospital between January 1995 and August 2001. All patients underwent PAND and pelvic lymph node dissection (114 patients had a radical hysterectomy; 103 patients had a simple hysterectomy). We evaluated postoperative ileus in three categories of severity. RESULTS: The average operation time and blood loss in the patients with radical and simple hysterectomies with PAND were 317 min and 1158 g, and 246 min and 820 g, respectively. The incidence of postoperative ileus was 12.9% (28/217). Although there were no significant differences in the occurrence of ileus between patients with the radical and simple hysterectomies (10.5% vs 15.5%), the incidence of ileus in patients with radical hysterectomy with PAND was significantly higher than that in a control group of patients with radical hysterectomy without PAND (10.5% vs 3.4%). However, in the PAND patients the postoperative ileus was mostly mild or moderate (10 mild cases, 15 moderate cases, and 3 severe cases). Severe ileus occurred in three patients with radical hysterectomy with PAND. Although a repeat operation was necessary for two of these three patients with severe ileus, they recovered uneventfully. CONCLUSION: PAND for malignant gynecologic tumors is a feasible and safe operative procedure, with a low incidence of postoperative ileus.

Female↗
PubMed2005

Early removal of nasogastric tube after cystectomy with urinary diversion: does postoperative ileus risk increase?

OBJECTIVES: To examine the risk factors of postoperative ileus and investigate whether the duration of postoperative nasogastric tube (NGT) use affects the rate of postoperative ileus in patients undergoing radical cystectomy with urinary diversion. METHODS: A total of 101 patients underwent radical cystectomy with urinary diversion from 1999 to 2003. We examined the demographic and perioperative variables of the patients who did and did not develop postoperative ileus. We divided the patients into two groups--those who had the NGT removed within 24 hours and those who had the NGT removed at first flatus. We compared the two groups for the incidence of ileus and clinical variables. RESULTS: Postoperative ileus was observed in 23 patients (23%). The demographic data of both groups were not different in terms of age or American Society of Anesthesiologists score. Also, the operative time, estimated blood loss, type of diversion, and postoperative complication rate were not significantly different between the two groups (P >0.05). However, the risk of postoperative ileus was significantly greater in those who took polyethylene glycol for bowel preparation than in those who took sodium phosphate (40% versus 18%, respectively, P = 0.02). No significant difference in the prevalence of ileus was found between the patients whose NGT was removed within 1 day and those in whom it was removed after 2 days (25% versus 22%, respectively, P >0.05). CONCLUSIONS: The results of our study suggest that the use of sodium phosphate for bowel preparation may reduce the incidence of postoperative ileus and that early NGT removal after cystectomy is not correlated with ileus.

Aged↗
PubMed1984

The meaning of ileus. Its changing definition over three millennia.

Ileus comes from the Greek word for twisted. The early classical literature suggests that this term was used for what we now call sigmoid volvulus. The Romans translated this word as volvulus. During later classical times, investigators used ileus and volvulus in describing conditions other than sigmoid volvulus. Roman investigators used ileus to describe midgut volvulus, intussusception, and incarcerated hernias because the symptoms of these conditions were similar. During the Renaissance, ileus, volvulus, and intussusception were synonymous and were closely linked to the volgar terms iliac passion and Miserere Mei. The sine qua non of ileus was the clinical triad of abdominal pain, obstipation, and fecal vomiting. Autopsies in the 16th, 17th, and 18th centuries exposed the various causes of these symptoms. Ileus became the clinical diagnosis whereas such terms as intussusception were used to describe autopsy findings. Physicians classified diseases by symptoms not by cause. During the 19th century, emphasis switched to the pathologic basis of disease. The classification of intestinal obstruction became one of cause. Ileus was abandoned because its classical definition did not encompass all forms of intestinal obstruction. In the last 50 years, ileus has been relegated to mean nonmechanical obstruction that does not initially require operative treatment. Thus, ileus which was the twisted intestine of Ascelpiades, the Miserere Mei of Paré and the iliac passion of Barrough, has come in the 20th century to mean nonmechanical intestinal obstruction.

Autopsy↗
PubMed1987

[Surgically treated mechanical ileus].

Between 1972 and 1983 a total of 351 patients was operated suffering from mechanical occlusion of the small intestine (n = 256) and of the colon (n = 95). The surgical complication rate amounted to 28.1% in cases of small intestine ileus and to 24.3% in cases of colon ileus; the most frequent complications were anastomotic dehiscences following resections (small intestine 17.7%/colon 33.8%), enterotomies (5.8%/27.2%), abdominal wall ruptures (3.5%/4.2%) and re-ileus (5.5%/3.2%). The medical complication rate (postop. pneumonia, pulmonary embolism, cardial decompensation etc.) amounted to 17.7% resp. 22.1%. All these complications carried a mortality of 20.6% in small intestine ileus and of 30.4% in colon ileus. The consequences of this retrospective analysis resulted in: early intensive care treatment, general perioperative thrombosis-, pneumonia- and stress ulcer prophylaxis, exact preoperative radiological diagnosis, strict indications for enterotomies and resections, sole transversostomy in stage of ileus for the left-sided colon obstruction caused by carcinoma, discontinuity resection by Hartmann in cases of inflammatory or perforated large bowel stenoses and tube decompression of the small bowel in cases of peritonitis or wide-spread adhesions. Since 1984 we could prospectively decrease the complication resp. mortality rate of the small intestine ileus (n = 64) to 9.4% resp. 4.7% and of the colon ileus (n = 20) to 10% resp. 5%.

Adolescent↗
PubMed1990

Postoperative ileus.

Postoperative ileus follows any operation. Although worsened if the peritoneum is entered, the length and duration of surgery does not influence the severity of postoperative ileus. Inhibitory alpha 2-adrenergic reflexes with peptidergic afferents contribute to postoperative ileus. Clinically, treatment of ileus centers around symptomatic relief with nasogastric suction. Trials of adrenergic blockade combined with cholinergic stimulation have met with limited success. Prokinetic drugs have not been proved effective in the treatment of this disorder. Two types of ileus exist: postoperative and paralytic. Postoperative ileus resolves spontaneously after two to three days, and probably reflects inhibition of colonic motility. Paralytic ileus is more severe, last more than three days, and seems to represent inhibition of small bowel activity. No discrete structural changes cause postoperative ileus and the role of peptidergic neuronal systems of the enteric nervous system has not been elucidated. Possible central or humoral mechanisms have not been studied extensively. The possible direct inhibition of enteric or spinal nerves by anesthetic agents not cleared from these tissues remains to be studied. Also in need of study is the potential alteration of neurotransmitter receptor activity within the enteric nervous plexus after manipulation of the bowel.

Gastrointestinal Motility↗
PubMed2004

Postoperative ileus: a review.

PURPOSE: Postoperatively, some patients experience a prolonged inhibition of coordinated bowel activity, which causes accumulation of secretions and gas, resulting in nausea, vomiting, abdominal distension, and pain. This prolonged inhibition can take days or weeks to resolve and often is referred to as postoperative paralytic ileus lasting more than three days after surgery. This article reviews the etiology, pathophysiology, and treatment options of postoperative ileus. METHODS: The relevant literature from 1965 to 2003 was identified and reviewed using MEDLINE database of the U.S. Medical Library of Medicine. Both retrospective and prospective studies were included in this review. RESULTS: The pathophysiology of postoperative ileus is multifactorial. The duration of postoperative ileus correlates with the degree of surgical trauma and is most extensive after colonic surgery. However, postoperative ileus can develop after all types of surgery including extraperitoneal surgery. A variety of treatment options have been used to decrease the duration of postoperative ileus. However, it is difficult to compare these studies because of small sample sizes and differences in operations performed, anesthesia protocols provided both intraoperatively and postoperatively, patient comorbidities, and in the measured end points, such as the time to the presence of bowel sounds, flatus, or bowel movements, tolerance of solid food, or discharge from the hospital. However, despite these drawbacks, some conclusions can be made. CONCLUSIONS: Paralytic postoperative ileus continues to be a significant problem after abdominal and other types of surgery. The etiology is multifactorial and is best treated with a combination of different approaches. Currently, the important factors that could effect the duration and recovery from postoperative ileus include limitation of narcotic use by substituting alternative medications such as nonsteroidals and placing a thoracic epidural with local anesthetic when possible. The selective use of nasogastric decompression and correction of electrolyte imbalances also are important factors to consider.

Anesthesia, Local↗
PubMed2001

Postoperative ileus in the lower extremity arthroplasty patient.

Postoperative ileus is a recognized complication of lower extremity surgery. In a review of 21,589 patients who underwent either total hip or total knee arthroplasty between 1988 and 1997, 0.32% developed postoperative ileus. The ileus lasted >3 days in 46% of patients. The purpose of this study was to investigate the risk factors associated with ileus during 3 days after total joint arthroplasty. The average age of the patients with prolonged ileus was 69.1 years, and 70% were male. The development of a prolonged ileus was associated significantly with younger age (P<.005) and male gender (P<.02). In total knee arthroplasty, more cases of postoperative ileus were seen in bilateral surgery. Patients who are younger, male, and undergoing bilateral total knee arthroplasty are at an increased risk of having a more prolonged postoperative ileus and should be monitored closely.

Aged↗
PubMedDate not supplied

Metoclopramide reversal of decreased gastrointestinal myoelectric and contractile activity in a model of canine postoperative ileus.

Postoperative ileus is characterized by decreased gastrointestinal myoelectric activity and motility. Metoclopramide was used to treat experimentally induced postoperative ileus in six dogs. Contractile activity was monitored by extraluminal strain gages on the pyloric antrum and proximal segment of the duodenum, and myoelectric activity was measured by recording bipolar electromyograms (EMGs) at the pyloric antrum, pyloric canal, proximal segment of the duodenum, proximal and distal parts of the jejunum, and ileum. Measurements were obtained from animals without ileus (baseline) and those with ileus that were either untreated or treated with metoclopramide. Adynamic ileus was induced by rubbing a 50 cm segment of jejunum with a dry sponge for 5 minutes and exposing the bowel to the air for 30 minutes. Treated dogs received metoclopramide (0.4 mg/kg 4 times daily [QID] intravenously [IV]), whereas untreated dogs received a saline placebo, starting 1 hour after celiotomy closure. Recordings were made for 26 hours after induction of ileus. The phases of the migrating myoelectric complex (MMC) were identified and motility index values were determined. During ileus, the MMC phase II duration was increased at the duodenum and phase III duration was decreased at the antrum, pylorus, duodenum, and proximal segment of the jejunum (p less than 0.05). Motility index values were decreased at the antrum and duodenum during ileus (p less than 0.05). Treatment with metoclopramide reversed the MMC phase III inhibition at the antrum and pylorus, and partially reversed the inhibition at the duodenum and jejunum (p less than 0.05). Motility index values were restored to preoperative baseline values with metoclopramide treatment (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Enhanced heart rate response to haemorrhage by ileus in the pig.

Effects of ileus on cardiovascular and hormonal responses to haemorrhage were evaluated in 10 anaesthetized pigs. Ileus was induced and the bleeding sequence repeated on the following day. Before ileus, a resting heart rate (HR) of 105 (range 83-140) beats min-1 remained unchanged until haemorrhage amounted to 15% of the blood volume. With a blood loss of 28% HR increased to a maximum of 162 (126-245) beats min-1. In contrast, ileus increased HR upon initiation of haemorrhage from a similar resting value to a maximum of 200 (152-250) beats min-1 (P < 0.0005). There were neither statistical differences in mean arterial pressure, cardiac output, central venous pressure, thoracic electrical impedance, pulmonary arterial mean pressure, pulmonary wedge pressure, pulmonary and systemic vascular resistances, nor in plasma concentrations of dopamine, adrenaline, vasopressin and aldosterone during haemorrhage before and after ileus. Plasma noradrenaline increased more with haemorrhage after than before ileus: from 2.8 (1.2-5.0) to 13 (2.3-59.0) vs. 3.0 (1.5-4.2) to 3.6 (2.7-17.5) nmol l-1 (P < 0.005). Also, the pancreatic polypeptide response to haemorrhage was enlarged with ileus (29 (0-60) to 90 (45-145) vs. 23 (0-64) to 57 (27-106) pmol l-1 (P < 0.005)). No significant differences could be detected in cardiovascular and hormonal responses to haemorrhage before and after a sham-operation in three pigs. Results demonstrate an immediate and enhanced HR response to haemorrhage in the pig with ileus, reflected in sympathetic activation as indicated by plasma noradrenaline.

Animals↗
PubMed1995

Ultrasonographic examination of the small intestine of cows with ileus of the duodenum, jejunum or ileum.

The small intestine of 35 heifers and cows with an ileus of the duodenum, jejunum or ileum was examined ultrasonographically. After a clinical examination, the animals were examined from the right flank and thorax with a 3.5 MHz linear transducer, and the findings were verified by a right flank laparotomy or post mortem. Dilated loops of small intestine with a diameter of more than 3.5 cm were visible in at least one location in all the animals; they were seen predominantly in cross-section or longitudinally. The number of loops of dilated intestine visible from the flank or intercostal spaces was markedly influenced by the site of the ileus. In animals with an ileus of the duodenum, only one intestinal loop was usually visible from the flank or from the 12th, 11th or 10th intercostal spaces. In contrast, more than five dilated loops of intestine were usually visible in animals with an ileus of the jejunum or ileum. The largest diameter of intestine measured from the 12th intercostal space was between 6.5 and 9.9 cm in animals with an ileus of the duodenum, between 3.5 and 9.8 cm in animals with an ileus of the jejunum, and between 4.4 and 5.5 cm in animals with an ileus of the ileum. In the majority of the cows, the contents of the intestines were predominantly echogenic, but in the others they were anechoic. The cause of the ileus could be identified by ultrasonography in only a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

[Ultrasonographic findings of adhesion ileus--with special reference to surgical indications].

Eighty-one cases with adhesion ileus were examined by ultrasonography from January 1983 to July 1987. In this study, the association of ultrasonographic findings with surgical indications for adhesion ileus was evaluated. The subjects were divided into three groups: Group I, consisting of 29 cases of simple ileus improved by conservative treatment; Group II, 24 cases of simple ileus which required surgical treatment and Group III, 28 cases of strangulation ileus. In comparison with Group I, Group mean value of II + III which required surgical treatment showed a significantly larger maximum diameter of the dilated intestine (3.2 +/- 0.7 cm for Group I vs 3.8 +/- 0.5 cm for Group mean value of II + III) and significantly higher incidences of wall thickening and ascites (respectively 21% and 31% from Group I vs 54% and 73% from Group mean value of II + III). In comparison with the cases of simple ileus (Group mean value of I + II), those of strangulation ileus (Group III) showed significantly higher incidences of akinetic dilated intestine and ascites (respectively 17% and 43% from Group mean value of I + II vs 93% and 86% from Group III). These results make us conclude that ultrasonography is highly useful in deciding surgical indications for adhesion ileus.

Humans↗
PubMed1995

[Laparoscopic therapy of mechanical or adhesion ileus of the small intestine--preliminary results].

Small bowel ileus is often caused by adhesions and might be treated by laparoscopic adhesiolysis. Therefore we tried to select those cases of ileus by anamnesis, clinical investigation, sonography and X-ray scan. 25 out of 74 patients with small bowel ileus were supposed to have ileus caused by adhesions and were further diagnosed by laparoscopy: 15 patients were operated laparoscopically, 5 were operated conventionally after diagnostic laparoscopy and 3 converted into open operation after laparoscopic start (conversion rate 12%). 2 patients showed ileus due to gastrointestinal infection without necessity of operation. Out of 49 (66.2%) ileus-patients operated conventionally 5 might have been operated laparoscopically. Thus, 15 of our patients with ileus of the small bowel (20.3%) were treated laparoscopically. Based on these results we suppose that following a proper selection about 25% of small bowel ileus can be treated adequately by laparoscopic adhesiolysis.

Diagnosis, Differential↗
PubMed1997

[Mechanical ileus from material of the IIIrd Department of Surgery at the College of Medicine of the Jagiellonian University].

Retrospective analysis of 177 patients with mechanical ileus was performed. The mean age was 16 to 94 years with average of 66. There were more females-107 (60.5%). There was 74.2% of strangulation ileus and 25.2% of obturation ileus. The incarcerated hernia was the main cause of strangulation ileus (59%) and carcinoma of obturation ileus (93%). Within the large bowel carcinoma was the cause of ileus in all patients. Postoperatively 33 patients (18.6%) died. Mortality among the patients with strangulation ileus was 13.6% and with obturation ileus was 33.3%.

Adolescent↗
PubMed2004

Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism.

Venous thromboembolic disease (VTD), deep venous thrombosis and pulmonary embolism, causes morbidity and mortality following total hip and total knee arthroplasties, while ileus complicates up to 4.0%. The clinical courses of 2,949 patients undergoing 3,364 consecutive primary and revision total hip and total knee arthroplasties, radical debridements, and reimplantations at one institution over a 2-year period were reviewed to examine the relationship between ileus and VTD. VTD prophylaxis consisted of aspirin and intermittent plantar pulse boots for all patients except those at high risk, who received parenteral chemical prophylaxis and boots. Ileus occurred in 62 patients (2.1%) and symptomatic DVT in 51 (1.7%). With ileus, the incidence of DVT was 8.1%: odds ratio 5.5 (P =.0036). Symptomatic pulmonary embolism occurred in 7 patients (0.24%); with ileus the incidence was 3.2%: odds ratio 19.6 (P =.0082). A significant increase was observed in rates of VTD with ileus. We recommend using parenteral chemical and mechanical prophylaxis in patients with ileus following total hip and total knee arthroplasties.

Arthroplasty, Replacement, Hip↗
PubMed2005

Is phototherapy a risk factor for ileus in high-risk neonates?

BACKGROUND: Abdominal distension and bile stained aspirates are common in high-risk neonates under phototherapy (PT). OBJECTIVE: To compare the incidence of ileus and related risk factors in extremely low birth weight (ELBW) neonates who did/did not receive PT. DESIGN/METHODS: Retrospective detailed analysis of data on 52 consecutive ELBW neonatal admissions (1997-1999) including demographic characteristics, outcomes to discharge and common risk factors for ileus such as intrauterine growth retardation, PDA, indomethacin therapy, sepsis and enteral feeds. Ileus was defined as presence of abdominal distension and bile stained aspirate/s with/without dilated bowel loops on X-rays. RESULTS: A significantly (p = 0.001) higher proportion (63.4%, 26/41) of neonates under PT developed ileus than those (1/11) who did not receive PT. The outcomes and risk factors for ileus were comparable between the two groups. Mean (+/-SD) gestational age and birth weight of those who did and did not receive PT [26 (+/-2.2) weeks and 803 (+/-133) grams vs. 27 (+/-3.2) weeks and 664 (+/-114.2) grams], and those who did and did not develop ileus [26.5 (+/-2.3) weeks and 797 (+/-102) grams vs. 28.0 (+/-1.2) weeks and 750 (+/-105) grams] were not significantly different. CONCLUSION: Phototherapy may be an independent risk factor for ileus in ELBW neonates.

Birth Weight↗
PubMed1965

LATE INTESTINAL OBSTRUCTION IN PATIENTS SURVIVING NEONATAL MECONIUM ILEUS.

Two of 15 children who survived neonatal meconium ileus had "meconium ileus equivalent." They were treated with hydration, pancreatic enzyme therapy and antibiotics. One of these children died from pulmonary disease at the time of the bowel obstruction. The survival rate of infants with meconium ileus is steadily improving because of prompt operative intervention, better preoperative and postoperative care and long-term treatment with enzyme supplements and antibiotics. Late intestinal obstruction due to adhesive bands, volvulus, intussusception or "meconium ileus equivalent" may occur in children previously treated for meconium ileus of infancy. The omission of pancreatic enzyme supplementation and the occurrence of respiratory infections are frequently associated with "meconium ileus equivalent."In this series of patients four of the infants treated surgically for neonatal meconium ileus died in the early postoperative period.

Anti-Bacterial Agents↗
PubMed2003

Mechanisms and treatment of postoperative ileus.

OBJECTIVE: To review the pathogenesis and treatment of postoperative ileus. DATA SOURCES: Data collected for this review were identified from a MEDLINE database search of the English-language literature. The exact indexing terms were "postoperative ileus," "treatment," "etiology," and "pathophysiology." Previous review articles and pertinent references from those articles were also used. STUDY SELECTION: All relevant studies were included. Only articles that were case presentations or that mentioned postoperative ileus in passing were excluded. DATA SYNTHESIS: The pathogenesis of postoperative ileus is complex, with multiple factors contributing either simultaneously or at various times during the development of this entity. These factors include inhibitory effects of sympathetic input; release of hormones, neurotransmitters, and other mediators; an inflammatory reaction; and the effects of anesthetics and analgesics. Numerous treatments have been used to alleviate postoperative ileus without much success. CONCLUSIONS: The etiology of postoperative ileus can best be described as multifactorial. A multimodality treatment approach should include limiting the administration of agents known to contribute to postoperative ileus (narcotics), using thoracic epidurals with local anesthetics when possible, and selectively applying nasogastric decompression.

Analgesics, Opioid↗
PubMed1989

Changing patterns of treatment and survival in neonates with meconium ileus.

This report describes 51 neonates with meconium ileus and emphasizes a changing pattern of treatment and improved survival. Twenty-four neonates had uncomplicated meconium ileus due to inspissated meconium obstructing the distal ileum. Twenty-seven neonates had 41 complications of meconium ileus including volvulus (18), bowel atresia (13), perforation (5), and giant cystic meconium peritonitis (5). Nine patients with uncomplicated cases responded to nonoperative clearing of meconium using a meglumine diatrizoate (Gastrografin) enema. Six of 7 patients with enema failures underwent laparotomy, purse-string enterotomy, and intraluminal irrigation. The remaining 9 patients with uncomplicated meconium ileus had resection and enterostomy. Complicated cases were managed by resection and anastomosis (13) or enterostomy (14). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 85% for those with complicated meconium ileus. Nonoperative Gastrografin enema or enterotomy-irrigation can relieve obstruction in uncomplicated meconium ileus and avoid an enterostomy in most cases.

Cystic Fibrosis↗