Further оutpatient сare

Care after discharge focuses on surgical convalescence and, if relevant, the need to care for the disease that caused the obstruction. An obstructing colon cancer may require postoperative chemotherapy, depending on the stage of the disease. The patient who is chronically obstipated may need stool softeners.

If the patient has received a colostomy or ileostomy, a decision regarding whether it is temporary or permanent may have been made at the time of discharge, depending on the patient’s diagnosis, comorbidity, and postoperative convalescence.

Most patients who retain a rectum are, at least in principle, candidates for reanastomosis at a subsequent stage. Generally, it is performed 2–3 months after the initial operation.

Careful counseling and assessment are required before proceeding with the second procedure. Counseling is directed at the risks of the second procedure because the patient must understand that this surgery is elective and that a colostomy or ileostomy is compatible with a reasonable lifestyle.

Often, local colostomy support groups and meeting with other patients with colostomies are helpful at this time. Patients who had stool incontinence before their first operation, those with substantial surgical risks, and patients with decreased mental status who are cared for in nursing homes may potentially be better off without a reanastomosis.

In addition, the remaining colon, both proximally and distally, must be evaluated radiographically or endoscopically to rule out synchronous colonic lesions such as neoplasms because the presence of the LBO prevented this from being performed before the first procedure.

Prognosis

Prior to surgical decompression, the patient’s overall medical condition and presence of any comorbidities that define surgical risk determine the prognosis. After surgical decompression, prognosis is determined by the underlying disease.

Ileus

After abdominal surgery, a normal physiological ileus occurs. This type of ileus spontaneously resolves within 2–3 days after sigmoid motility returns to normal. However, the terms postoperative adynamic ileus or paralytic ileus are defined as ileus of the gut persisting for more than 3 days following surgery. Ileus occurs from hypomotility of the gastrointestinal tract in the absence of a mechanical bowel obstruction. This suggests that the muscle of the bowel wall is transiently impaired and fails to transport intestinal content. This lack of coordinated propulsive action leads to the accumulation of both gas and fluids within the bowel. Although ileus has numerous causes, the postoperative state is the most common scenario for ileus development. Frequently, ileus occurs after intraperitoneal operations, but it may also occur after retroperitoneal and extra-abdominal surgery. The longest duration of ileus is noted to occur after colonic surgery.

Causes

Causes of adynamic ileus:

1. Most cases of ileus occur after intra-abdominal operations.

2. Sepsis.

3. Drugs (e.g., opioids, antacids, coumarin, amitriptyline, chlorpromazine).

4. Metabolic (e.g., low potassium, magnesium, or sodium levels; anemia, hyposmolality).

5. Myocardial infarction.

6. Pneumonia.

7. Trauma (e.g., fractured ribs, fractured spine).

8. Biliary and renal colic.

9. Head injury and neurosurgical procedures.

10. Intra-abdominal inflammation and peritonitis.

11. Retroperitoneal haematomas.