An update on equine post-operative ileus: Definitions, pathophysiology and management.
Authors: Lisowski Z M, Pirie R S, Blikslager A T, Lefebvre D, Hume D A, Hudson N P H
Journal: Equine veterinary journal
Summary
# Editorial Summary: Post-operative Ileus in Equine Practice Post-operative ileus (POI) remains a significant complication following abdominal surgery in horses, substantially prolonging hospitalisation and inflating treatment costs, yet current evidence suggests we still lack a definitive therapeutic solution. Lisowski and colleagues synthesised recent literature to advance our understanding of POI pathophysiology, identifying mechanical manipulation of viscera during surgery as a key inflammatory trigger that activates resident macrophages within the muscularis externa—a mechanism largely extrapolated from human and small animal models where the condition has been more extensively characterised. The review emphasises that despite numerous pharmacological interventions tested across species, no single treatment has proven consistently effective, indicating that POI is fundamentally multifactorial in origin rather than governed by a single mechanistic pathway. For practitioners involved in post-operative management—whether surgical, medical, nutritional or rehabilitation-focused—the practical implication is clear: preventing or managing POI demands coordinated, multimodal protocols that address inflammation, restore motility and support metabolic stability simultaneously, rather than relying on any single intervention. Understanding the inflammatory basis of POI provides a framework for reconsidering adjunctive therapies including anti-inflammatory medications, feeding strategies and physical management to mitigate what remains one of the most challenging post-operative complications in equine surgery.
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Practical Takeaways
- •Expect POI as a significant post-operative complication in abdominal surgery cases; implement multimodal management strategies rather than relying on single treatments
- •Understand that surgical manipulation triggers inflammatory cascades involving macrophage activation; consider surgical technique and perioperative anti-inflammatory protocols
- •Plan for extended hospitalisation and increased costs when advising clients on abdominal surgery; discuss POI risk and management options preoperatively
Key Findings
- •Post-operative ileus is a serious complication in horses following abdominal surgery that increases hospitalisation time and costs
- •Manipulation-induced inflammation and activation of resident muscularis externa macrophages are key triggers in the pathophysiology of equine POI
- •No single pharmacological treatment has proven completely successful for POI, indicating the condition is multifactorial and requires multimodal management approaches