Therapeutic target
- Restoration of intestinal peristalsis and pain relief.
Therapy recommendations
If the patient’s symptoms are indicative of an incomplete ileus (= restricted food passage), conservative therapy can be used initially. This approach necessitates close reevaluation (reassessment of findings or a situation in the course of disease). In case of doubt, surgery must always be performed.
The ileus patient must be treated preoperatively according to the Surviving Sepsis Campaign(SSC) guidelines (see boldface below].
Conservative therapy consists of:
- Treatment of the underlying disease
- Gastric tube (for vomiting)
- Food abstinence or at most sip tea; parenteral (“bypassing the intestine”) nutrition.
- Compensation of electrolyte losses (blood salts) and at the same time volume administration (balanced full electrolyte solutions).
- Stabilization of a hypotonic circulatory situation.
- Start of a calculated antibiosis (antibiotic therapy), esp. in:
- Secondary peritonitis (peritonitis due to ileus).
- Spontaneous bacterial peritonitis (SBP; inflammation of ascites (abdominal fluid) without an obvious source of inflammation).
- If necessary, motility enhancement/increase of bowel activity (as far as paralytic ileus/paralysis of smooth muscle is present): e.g. dopamine agonists, cholecystokinin analogues, parasympathomimetics, motilin agonist; laxatives (laxatives).
- Analgesia (analgesics/pain relievers; use only short-term for severe pain).
- See also under “Further therapy“.
