Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

被引:31
作者
Wu, Zhouqiao [1 ]
Boersema, Geesien S. A. [1 ]
Dereci, Adem [1 ]
Menon, Anand G. [3 ]
Jeekel, Johannes [2 ]
Lange, Johan F. [1 ]
机构
[1] Erasmus Univ, Med Ctr, Dept Surg, NL-3000 CA Rotterdam, Netherlands
[2] Erasmus Univ, Med Ctr, Dept Neurosci, NL-3000 CA Rotterdam, Netherlands
[3] Havenziekenhuis, Dept Surg, Rotterdam, Netherlands
关键词
Postoperative ileus; Paralytic ileus; Prediction; Endpoint; Differential diagnosis; SMALL-BOWEL OBSTRUCTION; OPEN SIGMOID COLECTOMY; INTESTINAL-OBSTRUCTION; COLORECTAL-CARCINOMA; ANASTOMOTIC LEAKAGE; ABDOMINAL EXUDATE; RISK-FACTORS; SURGERY; INFLAMMATION; ACTIVATION;
D O I
10.1159/000369529
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI). Methods: Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized. Results: Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-alpha might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c). Conclusions: Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need. (C) 2014 S. Karger AG, Basel
引用
收藏
页码:127 / 138
页数:12
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