Prognosis

Prior to surgical decompression, the patient’s overall medical condition and presence of any comorbidities that define surgical risk determine the prognosis. After surgical decompression, prognosis is determined by the underlying disease.

Ileus

After abdominal surgery, a normal physiological ileus occurs. This type of ileus spontaneously resolves within 2–3 days after sigmoid motility returns to normal. However, the terms postoperative adynamic ileus or paralytic ileus are defined as ileus of the gut persisting for more than 3 days following surgery. Ileus occurs from hypomotility of the gastrointestinal tract in the absence of a mechanical bowel obstruction. This suggests that the muscle of the bowel wall is transiently impaired and fails to transport intestinal content. This lack of coordinated propulsive action leads to the accumulation of both gas and fluids within the bowel. Although ileus has numerous causes, the postoperative state is the most common scenario for ileus development. Frequently, ileus occurs after intraperitoneal operations, but it may also occur after retroperitoneal and extra-abdominal surgery. The longest duration of ileus is noted to occur after colonic surgery.

Causes

Causes of adynamic ileus:

1. Most cases of ileus occur after intra-abdominal operations.

2. Sepsis.

3. Drugs (e.g., opioids, antacids, coumarin, amitriptyline, chlorpromazine).

4. Metabolic (e.g., low potassium, magnesium, or sodium levels; anemia, hyposmolality).

5. Myocardial infarction.

6. Pneumonia.

7. Trauma (e.g., fractured ribs, fractured spine).

8. Biliary and renal colic.

9. Head injury and neurosurgical procedures.

10. Intra-abdominal inflammation and peritonitis.

11. Retroperitoneal haematomas.