Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

Abstract

Background: This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI). Methods: Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized. Results: Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-α might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c). Conclusions: Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need. © 2014 S. Karger AG, Basel

Chewing Gum in Preventing Postoperative Ileus in Women Undergoing Cesarean Section

“…POI is an admittedly difficult to define clinical entity and recent reviews have been conducted for the sole purpose of better defining it. 1,2 The results suggest that tolerance/intolerance to diet is a critical clinical determinant of whether an ileus is present yet the current study did not comment on these markers. Moreover, measurements of inflammatory mediators are even more likely to confirm the presence of POI.…”

Clinical Safety and Efficacy of Nasogastric Tube placement after Gastrectomy

“…Our data, in accordance with the meta-analyses [3,19] and the prospective randomized controlled trial [10], showed no effect in this regard. However, it is important to notice that actually the time to flatus is not a good indicator of the bowel function recovery [20], let alone its occurrence is quite subjective in clinical practice. In contrast, the study by van Bree [21] indicates that tolerance of solid food and first defecation are better indicator of bowel function recovery instead.…”

Prolonged postoperative ileus after elective colorectal cancer surgery

“…Distinguishing other postoperative complications from PPOI is of paramount importance since symptoms of PPOI are similar to, for example, postoperative small-bowel obstruction or anastomotic leakage or intraperitoneal bleeding. Many of these complications require immediate intervention since they are life-threatening conditions 4 .…”

“…Opiate based medications are often mentioned factor involving in pathophysiology of postoperative ileus for its inhibitory effect through stimulation of µ-opioid receptors in the bowel 2,3 . Various terms can be found in literature addressing the same problem, from postoperative paralytic ileus, prolonged ileus, and pathologic ileus 4 . To make reporting and research on the subject more comprehensive, there is a need for clearer definition of the factors that constitute prolonged postoperative ileus (PPOI) with increased awareness and recognition of its impact 5 .…”

“…Risk factors vary between different studies 6 . Symptoms of postoperative ileus include nausea and vomiting, abdominal distension, lack of bowel sounds, passage of flatus and defecation 4 . Intolerance of oral intake due to nausea and vomiting aggravate catabolism which further compromises recovery 7 .…”