Persistent postoperative ileus versus partial small bowel obstruction: a diagnostic and therapeutic challenge

David Bursalyan

doi:10.18203/2349-2902.isj20253843

Authors

David Bursalyan College of Osteopathic Medicine, Touro University, Nevada, USA

DOI:

https://doi.org/10.18203/2349-2902.isj20253843

Keywords:

Postoperative ileus, Small bowel obstruction, Ventral hernia repair, Nasogastric tube, Palliative care

Abstract

Distinguishing postoperative ileus (POI) from early mechanical small bowel obstruction (SBO) remains a challenging clinical dilemma after abdominal surgery, especially among elderly, frail patients with baseline gastrointestinal dysfunction. We describe an 83-year-old man with multiple comorbidities who underwent a robotic umbilical hernia repair converted to open due to incarcerated omentum and small-bowel dilation. The postoperative course was notable for persistent abdominal distention, high nasogastric output, alternating imaging interpretations of jejunal obstruction versus ileus, severe malnutrition requiring total parenteral nutrition, multidrug-resistant urinary infection, and progressive debility. Despite partial return of bowel function, the patient remained debilitated and elected hospice care. This case underscores the diagnostic ambiguity between persistent POI and partial SBO, emphasizes multidisciplinary management, and highlights the importance of aligning treatment with patient-centered goals in frail postoperative patients.

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References

Vather R, Bissett I. Management of prolonged post-operative ileus: evidence-based recommendations. ANZ J Surg. 2013;83(5):319-24. DOI: https://doi.org/10.1111/ans.12102

Luckey A, Livingston E, Tache Y. Mechanisms and treatment of postoperative ileus. Arch Surg. 2003;138(2):206-14. DOI: https://doi.org/10.1001/archsurg.138.2.206

Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, Meurette G. Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg. 2016;153(6):439-46. DOI: https://doi.org/10.1016/j.jviscsurg.2016.08.010

Vather R, Trivedi S, Bissett IP. Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg. 2013;17(5):962-72. DOI: https://doi.org/10.1007/s11605-013-2148-y

Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction. World J Emerg Surg. 2018;13:24. DOI: https://doi.org/10.1186/s13017-018-0185-2

Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. World J Surg. 2000;24(4):421-6. DOI: https://doi.org/10.1046/j.1365-2168.2000.01530.x

Maung AA, Johnson DC, Piper GL, Barbosa RR, Bromberg WJ, Chang PK, et al. Evaluation and management of small-bowel obstruction: Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5-4):S362-9. DOI: https://doi.org/10.1097/TA.0b013e31827019de

Doorly MG, Senagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Surg Clin North Am. 2012;92(2):259-72. DOI: https://doi.org/10.1016/j.suc.2012.01.010

Asgeirsson T, El-Badawi KI, Mahmood A, Barletta J, Luchtefeld M, Senagore AJ. Postoperative ileus: it is not just about the gut. World J Gastroenterol. 2010;16(17):2067-70.

ten Broek RPG, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bakkum EA, Rovers MM, van Goor H. Burden of adhesions in abdominal and pelvic surgery: systematic review and meta-analysis. Ann Surg. 2013;258(1):98-106. DOI: https://doi.org/10.1136/bmj.f5588

Barkan H, Webster S, Ozeran S. Factors predicting the recurrence of adhesive small-bowel obstruction. Am J Surg. 1995;170(4):361-5. DOI: https://doi.org/10.1016/S0002-9610(99)80304-3

Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, et al. Water-soluble contrast medium (Gastrografin) value in adhesive small bowel obstruction: a systematic review and meta-analysis. World J Surg. 2013;37(10):2347-55.