Epidemiology
Ileus is commonly seen in the postoperative setting. Prevalence is difficult to assess because ileus is often considered a normal consequence of surgery so is not always reported as a complication. Furthermore, the various definitions in the literature are inconsistent, making the incidence even more difficult to quantify.[9][5]
Postoperative ileus occurs in approximately 10% to 30% of patients undergoing abdominal surgery.[10][11][12][13][14][15] Colorectal surgery (open or laparoscopic) is associated with an incidence of postoperative ileus of approximately 10%.[16] Postoperative ileus occurs in up to 1 in 8 patients undergoing abdominal surgery but it can also occur following other types of surgery such as cardiac or orthopaedic procedures.[17][18][19][20][21]
Postoperative ileus is responsible for a significant prolongation of hospital stay. Approximately 10% of patients are re-admitted to hospital after undergoing major abdominal surgery, and approximately half of these re-admissions are due to delayed onset of postoperative ileus.[22]
Risk factors
This is a major risk factor. Postoperative ileus occurs in approximately 10% to 30% of patients undergoing abdominal surgery.[10][11][12][13][14][15] The stress responses to incision of the peritoneum and bowel manipulation, and to general anaesthesia, and postoperative factors such as immobilisation, pain, and slow resumption of oral diet, contribute to the development of ileus.[6]
Using invasive surgical techniques such as laparotomy and performing longer operations (i.e., the degree of surgical bowel manipulation) are major risk factors for developing postoperative ileus.[28] This is mitigated by using minimally invasive surgical techniques (e.g., laparoscopy) whenever possible.[28]
Particularly sodium, potassium, chloride, magnesium, and calcium.
May be a consequence of ileus or an exacerbating factor.
Patients who are nil by mouth, and who may have a nasogastric tube in place or are vomiting, are predisposed to abnormalities such as hypo-chloraemia or hypokalaemia.
In turn, these or other electrolyte problems may interfere with the normal motility of the bowel, exacerbating the condition.
Opioid-based analgesics interfere with gastrointestinal motility.[6] This often manifests as severe constipation, but may also present as ileus.
Some anticholinergic and anaesthetic agents (e.g., atropine, halothane, enflurane) affect motility, contributing to the development of postoperative ileus.[31]
Gastroparesis in diabetes mellitus, and intestinal ischaemia associated with cardiovascular insufficiency, can contribute to gastrointestinal motility disorders due to the low blood flow.
Autoimmune or infectious diseases, such as scleroderma or Chagas disease, are associated with motility disorders and may exacerbate ileus.
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