When to re-operate on a colic and what is the likely outcome?

Postoperative ileus and recurring colic are considered the most commonly encountered problems after exploratory celiotomy. If severe or unrelenting, both might lead to a second celiotomy. Continued reflux in postoperative colic patients is one of the most common reasons for non-survival [1]. It is frequently caused by postoperative ileus, small intestinal anastomosis problems or, slightly less common, early fibrin deposition and adhesion formation. Differentiating these underlying conditions confidently on clinical grounds is close to impossible. A recent investigation suggested that need for analgesia shortly after the first surgery and larger volumes of reflux might indicate the presence of ileus [2]. However, overlap between cases was too large to differentiate a functional from a mechanical obstruction. Therefore, postoperative reflux is frequently initially treated conservatively, including time and prokinetics, assuming that ileus is the underlying problem. If reflux continues, a second exploration might become necessary to rule out a mechanical obstruction and also to decompress the small intestine. The best time point for repeated celiotomy is not known ...