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Postoperative ileus: pathogenesis and treatment.
Abstract: Surgical manipulation of the intestines activates intestinal macrophages that release cytokines and nitric oxide, which results in inhibition of intestinal motility. Subsequent infiltration of circulating leukocytes into the intestinal wall contributes to cytokine and nitric oxide release and exacerbates ileus. Other factors contributing to ileus are endotoxemia; edema of the intestine wall subsequent to excessive fluid therapy; hypocalcemia; and long abdominal incisions. Because treatment of ileus with prokinetic drugs has not proven to be very effective, efforts should be directed at reducing its severity. Strategies which reduce the severity of ileus include pretreatment with a nonsteroidal anti-inflammatory drug, minimizing the length of the abdominal incision, reducing intestinal manipulation, intraoperative lidocaine infusion, correction of hypocalcemia, limiting the volume of intravenous fluids to prevent intestinal edema, and administration of alpha(2) antagonists.
Publication Date: 2009-07-08 PubMed ID: 19580945DOI: 10.1016/j.cveq.2009.04.011Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
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The study explores the causes and potential treatments of postoperative ileus, a common complication characterized by inhibited intestinal movement following surgery. The research aims to improve methods for managing this condition, as conventional treatments have shown limited effectiveness.
Pathogenesis of Postoperative Ileus
Postoperative ileus is the outcome of a multi-process pathology that begins with surgical manipulation of the intestine. This causes:
- Activation of intestinal macrophages, a type of immune cell, which release substances including cytokines and nitric oxide.
- Interruption of intestinal motility due to these substances.
- Circulating leukocytes (white blood cells) infiltrating the intestinal wall, enhancing the release of cytokines and nitric oxide, and exacerbating the ileus condition.
Factors that further contribute to ileus include:
- Endotoxemia, a potentially harmful condition involving the release of toxins into the bloodstream from Gram-negative bacteria.
- Excessive fluid therapy leading to intestinal wall edema (swelling due to fluid accumulation).
- Hypocalcemia or low calcium levels in the blood.
- Long abdominal incisions made during surgery.
Inadequacy of Current Treatment
The study asserts that the treatment of ileus with prokinetic drugs, designed to enhance gastrointestinal motility, hasn’t been remarkably effective. As a result, a call is made for efforts to focus on reducing the severity of the condition.
Proposed Strategies for Effective Management
The researchers propose a series of strategies that can potentially decrease the severity of postoperative ileus:
- Pretreatment with nonsteroidal anti-inflammatory drugs (NSAID) before surgery.
- Minimizing the length of the abdominal incision.
- Reducing the extent of surgical manipulation of the intestines.
- Infusing lidocaine, a local anesthetic, during surgery.
- Correction of hypocalcemia or low levels of calcium in the blood.
- Limiting the volume of intravenous fluids administered during surgery, thus preventing the swelling of the intestinal wall.
- Administration of alpha(2) antagonists, a class of drugs that block the effects of certain natural substances in the body.
Cite This Article
APA
Doherty TJ.
(2009).
Postoperative ileus: pathogenesis and treatment.
Vet Clin North Am Equine Pract, 25(2), 351-362.
https://doi.org/10.1016/j.cveq.2009.04.011 Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, The University of Tennessee College of Veterinary Medicine, 2407 River Drive, Knoxville, TN 37996, USA. tdoherty@utk.edu
MeSH Terms
- Animals
- Colic / surgery
- Colic / veterinary
- Digestive System Surgical Procedures / adverse effects
- Digestive System Surgical Procedures / veterinary
- Gastrointestinal Agents / therapeutic use
- Horse Diseases / etiology
- Horse Diseases / pathology
- Horse Diseases / therapy
- Horses
- Ileus / complications
- Ileus / therapy
- Ileus / veterinary
- Postoperative Complications / pathology
- Postoperative Complications / veterinary
Citations
This article has been cited 8 times.- Guo JF, Zhao YT, Du QY, Ren Y, Wang Y, Wang ZX, Jin W. The Network Pharmacology Study of Dahuang Fuzi Decoction for Treating Incomplete Intestinal Obstruction. Biomed Res Int 2022;2022:2775434.
- St James ML, Kosanovich DL, Snyder LB, Zhao Q, Jones BG, Johnson RA. Effects of acupuncture at Pericardium-6 and Stomach-36 on nausea, sedation and gastrointestinal motility in healthy dogs administered intravenous lidocaine infusions. PLoS One 2019;14(12):e0226065.
- Staikou C, Avramidou A, Ayiomamitis GD, Vrakas S, Argyra E. Effects of intravenous versus epidural lidocaine infusion on pain intensity and bowel function after major large bowel surgery: a double-blind randomized controlled trial. J Gastrointest Surg 2014 Dec;18(12):2155-62.
- Chakravarty A, Anand S, Sapra H, Mehta Y. Undetected hypoparathyroidism: An unusual cause of perioperative morbidity. Indian J Anaesth 2014 Jul;58(4):470-2.
- Wendt-Hornickle EL, Snyder LB, Tang R, Johnson RA. The effects of lactated Ringer's solution (LRS) or LRS and 6% hetastarch on the colloid osmotic pressure, total protein and osmolality in healthy horses under general anesthesia. Vet Anaesth Analg 2011 Jul;38(4):336-43.
- Augestad KM, Delaney CP. Postoperative ileus: impact of pharmacological treatment, laparoscopic surgery and enhanced recovery pathways. World J Gastroenterol 2010 May 7;16(17):2067-74.
- Xiao JH, Wei JX, Bi ZT, Huang L, Dai YH, Zhang YS. Efficacy of multimodal rehabilitation strategies on gastrointestinal function recovery in postoperative aortic dissection patients: a narrative review. Front Physiol 2025;16:1671629.
- Steiger C, Abramson A, Nadeau P, Chandrakasan AP, Langer R, Traverso G. Ingestible Electronics for Diagnostics and Therapy. Nat Rev Mater 2019 Feb;4(2):83-98.
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