Treatment for Ileus

Initial Management

The American College of Physicians recommends isotonic intravenous fluids, such as lactated Ringer's or normal saline, for patients with ileus, with moderate evidence supporting this strong recommendation 1
Nasogastric tube placement may be necessary in patients with severe abdominal distention, vomiting, or risk of aspiration, as recommended by the Centers for Disease Control and Prevention 2
Intravenous rehydration should be continued until pulse, perfusion, and mental status normalize, and the patient has no evidence of ileus, according to the Infectious Diseases Society of America 1

The Infectious Diseases Society of America recommends maintenance fluids be administered until bowel function returns, once rehydration is complete 1
Nutritional support may be necessary if ileus is prolonged, with parenteral nutrition considered in cases of prolonged ileus, as suggested by the European Society of Gastrointestinal Endoscopy 3

Alvimopan, a μ-opioid receptor antagonist, can accelerate gastrointestinal recovery in postoperative ileus when opioid analgesia is being used, according to the European Society for Clinical Nutrition and Metabolism 4, 5
Chewing gum has been shown to have a positive effect on postoperative ileus duration and can be recommended, as suggested by the European Society for Clinical Nutrition and Metabolism 4, 5
Oral magnesium oxide may promote bowel function in postoperative ileus, according to the European Society for Clinical Nutrition and Metabolism 4

Mid-thoracic epidural analgesia is highly effective at preventing postoperative ileus compared to intravenous opioid analgesia, as recommended by the European Society for Clinical Nutrition and Metabolism 4, 5
Laparoscopic surgical approaches lead to faster return of bowel function compared to open surgery, according to the European Society for Clinical Nutrition and Metabolism 4, 5
Avoid fluid overloading during and after surgery as it impairs gastrointestinal function, as suggested by the European Society for Clinical Nutrition and Metabolism 4, 5
Avoid routine nasogastric decompression as it may prolong the duration of ileus, according to the European Society for Clinical Nutrition and Metabolism 4

In cases of ileus associated with Clostridium difficile infection, specific antimicrobial therapy is required, and parenteral metronidazole can be used when oral administration is not possible, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 6
For ileus in neutropenic enterocolitis, broad-spectrum antibiotics covering enteric gram-negative organisms, gram-positive organisms, and anaerobes should be administered, according to the European Society for Medical Oncology 7
Anticholinergic, antidiarrheal, and opioid agents should be avoided in neutropenic enterocolitis as they may aggravate ileus, as recommended by the European Society for Medical Oncology 7

Resume oral intake gradually once bowel function returns, starting with clear liquids and advancing as tolerated, according to the Infectious Diseases Society of America 1