Postoperative Ileus A SPECIAL ARTICLE

13 INTRODUCTION Postoperative ileus (POI) is a very common problem after many surgical procedures, may lead to significant patient morbidity, and is a common reason for gastroenterological consultation. POI may be generally defined as transient inhibition of normal GI motility in the postoperative setting, typically lasting 3-5 days after surgery. Clinical consequences of POI include worsened postoperative pain, nausea and vomiting, delay in resuming enteral nutrition, and prolonged hospitalization. Other postoperative complications, including deconditioning, malnutrition, and increased risk of nosocomial infections and pulmonary complications, may also be increased. (Table 1) The economic impact of POI is significant, estimated to be $750 million in the US in 1986 and approaching $1 billion in 2000 (1). Despite its pervasiveness, the pathophysiology of POI remains poorly understood, and treatment options are currently limited. Several mechanisms are thought to play a role in POI, including sympathetic neural reflexes, local and systemic inflammatory mediators, and changes in various neural and hormonal transmitters. Treatment is generally supportive in nature, and clinical trials evaluating different therapies are often limited by small size, retrospective design, and/or endpoints that make comparisons to other trials difficult. This article focuses on our current understanding of the pathophysiology of POI, and will review the clinical presentation, evaluation, and current treatment options in patients with POI.