124 - Ileus and Pseudo-Obstruction Syndromes

Abstract

This chapter reviews the epidemiology, pathophysiology, clinical features, and management of small and large intestinal motility disorders. Based on the onset and duration, the acute conditions, which are typically reversible, are referred to as ileus and acute colonic pseudo-obstruction. By contrast, chronic intestinal pseudo-obstruction and chronic megacolon, which respectively affect the small intestine and colon, are irreversible. After abdominal or retroperitoneal surgery, transient postoperative ileus is inevitable, benign, and self-limited. Prolonged (or pathologic) postoperative ileus is defined by delayed recovery of intestinal function in the absence of mechanical intestinal obstruction and is secondary to bowel manipulation followed by inflammation. Enhanced Recovery Programs/Pathways are the cornerstone to preventing and managing postoperative ileus. Acute colonic pseudoobstruction (Ogilvie syndrome) is characterized by acute massive colon dilatation in the absence of mechanical obstruction and usually occurs in older adults, hospitalized patients, or institutionalized patients with serious underlying medical or surgical conditions. It is generally reversible and managed with cholinesterase inhibitors, bowel decompression, and supportive measures. Chronic idiopathic intestinal pseudo-obstruction and chronic megacolon are uncommon, generally idiopathic and sporadic, less frequently familial disorders that result from injury to the enteric neuromuscular apparatus or autonomic nervous system that are defined by recurrent or persistent features of intestinal obstruction in the absence of an anatomic lesion that obstructs the flow of intestinal contents. Chronic idiopathic intestinal pseudo-obstruction is often associated with high morbidity and mortality; the emphasis is on nutrition management, propulsion restoration, and bowel decompression. When necessary and feasible, patients with chronic megacolon should undergo a colectomy.