Post Operative Ileus - Can We Prevent It?

Historically, post operative ileus (POI) was defined as any post operative complication that resulted in reduced intestinal transport. More recently, the term has been taken to describe a syndrome of (transient) gastrointestinal motility disturbance that is seen shortly after abdominal surgery. In particular, it is related to procedures involving intestinal manipulation. Mechanical obstructions are usually specifically excluded and POI is considered a functional obstruction in which, in most cases, pharmacological treatment is beneficial. The motility disturbance may affect any segment of the gastrointestinal tract, although in horses the stomach and small intestine appear more susceptible. In equine clinical practice, the presence of an increased volume of gastric reflux on stomach intubation after colic surgery is commonly regarded as pathognomonic for POI (although the precise criteria to determine an increased amount of reflux are open to debate). Other clinical signs usually include colic, reduced intestinal borborygmi, tachycardia and dehydration (Merritt and Blikslager 2008). More recently, this view of the pathogenesis of POI has been questioned and the possible role of mechanical obstruction to the intestinal tract has been proposed (Freeman 2008).

The incidence of POI has been reported to be 10–47% of abdominal surgeries and there is a reported mortality of 13–86% of cases of POI (Blikslager et al. 1994; Freeman et al. 2000; Frenchet al. 2002; Morton and Blikslager 2002; Mair and Smith 2005). POI has been associated with 38–40% of post operative deaths in horses treated for colic (Blikslager et al. 1994; Roussel et al.2001). [...]