Postoperative Ileus: Comparative Pathophysiology and Future Therapies.
Authors: Hellstrom Emily A, Ziegler Amanda L, Blikslager Anthony T
Journal: Frontiers in veterinary science
Summary
# Editorial Summary Postoperative ileus (POI)—the reduction in gastrointestinal motility following surgical intervention—represents a substantial clinical challenge in equine practice, with mortality rates reaching 37.5% in horses requiring small intestinal resection. This review synthesises current understanding of POI pathophysiology, which involves two interconnected mechanisms: an initial neurogenic phase triggered by surgical trauma, subsequently amplified by inflammatory cascade activation. Perioperative management decisions significantly influence POI severity; opioid analgesics, suboptimal fluid therapy and electrolyte disturbances have all been implicated as contributing factors, whilst current treatment protocols—incorporating early refeeding, NSAIDs to dampen inflammatory response, and prokinetic agents such as lidocaine—show variable efficacy with considerable controversy surrounding optimal protocols. Emerging evidence suggests that the gastrointestinal microbiota, intestinal barrier integrity, enteric glial cells within the enteric nervous system, and post-surgical inflammatory dynamics may represent promising intervention targets; a more nuanced understanding of these mechanisms could substantially improve POI prevention and treatment outcomes in equine patients undergoing colic surgery.
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Practical Takeaways
- •Horses requiring small intestinal resection face significant mortality risk from postoperative ileus; optimize perioperative care protocols including careful opioid dosing and fluid/electrolyte management
- •Early return to feeding combined with NSAIDs and prokinetics (lidocaine) are current standard approaches, but optimal protocols remain undefined—consult current clinical guidelines
- •Understanding gut barrier function, microbiota changes, and enteric nervous system involvement may lead to improved prevention strategies in future
Key Findings
- •37.5% of horses developing POI following small intestinal resection do not survive to discharge
- •POI pathophysiology involves two major phases: neurogenic phase followed by inflammatory phase
- •Perioperative factors including opioid therapy, fluid therapy, and electrolyte imbalances contribute to POI development
- •Current POI management combines early feeding, NSAIDs, and prokinetic agents like lidocaine with variable efficacy