Postoperative ileus: pathogenesis and treatment.
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.
Doherty
Thomas J
TJ
Department of Large Animal Clinical Sciences, The University of Tennessee College of Veterinary Medicine, 2407 River Drive, Knoxville, TN 37996, USA. tdoherty@utk.edu
D000818:Animals; D003085:Colic / Q000601:surgery / Q000662:veterinary; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000662:veterinary*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006734:Horse Diseases / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006736:Horses; D045823:Ileus / Q000150:complications / Q000628:therapy / Q000662:veterinary*; D011183:Postoperative Complications / Q000473:pathology / Q000662:veterinary*
D005765:Gastrointestinal Agents