Ileus in critical illness: mechanisms and management
Abstract
Nonobstructive ileus, signifying the impairment of coordinated propulsive intestinal motility, remains a frequently documented and almost inevitable consequence of open abdominal surgery and sepsis. Despite the frequency and major impact of ileus on morbidity and mortality, the exact underlying molecular and cellular mechanisms of this important clinical conundrum are still ill defined. Animal models suggest that both neuronal and local inflammatory responses within the intestinal muscularis mechanistically contribute to intestinal ileus. The neuronal mechanism appears to involve the enhanced release of nitric oxide from inhibitory motor neurons. Likewise, nitric oxide and prostaglandins are released from inflammatory cells (macrophages and monocytes) via the induction of nitric oxide synthase (iNOS) and cyclooxygenase-2. Recently, preliminary data have confirmed the existence of an intraoperative local muscularis inflammatory response during surgery in human patients.
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The pathogenesis of ileus is mediated by overproduction of cytokines in the bowel, which interferes with smooth muscle function.
“The pathogenesis of ileus, a complication of abdominal surgery or trauma characterized by gastrointestinal hypomotility and delayed gastric emptying, is mediated by the overproduction of cytokines in the bowel, which interferes with smooth muscle function (48,49).”
From Physiology and immunology of the cholinergic antiinflammatory pathway (2007) · cites this paper as [48]
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Physiology and immunology of the cholinergic antiinflammatory pathway
Tracey, K. J. (2007) · Journal of Clinical Investigation · doi:10.1172/jci30555 · Cited by 1,563 · see citing works
Mechanisms of postoperative ileus
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Self-citation
- Authors
- Bauer, A. J., Schwarz, N. T., Moore, B. A., T??rler, A., & Kalff, J. C.
- Affiliations
- University of Pittsburgh Medical Center (US)
- University of Bonn (DE)
- Corresponding author
- Bauer, Anthony J.
- Moore, Beverley A.
- ORCID
- Moore, Beverley A.
- Venue
- Current Opinion in Critical Care
- Published
- 2002-04
- Volume
- 8
- Issue
- 2
- Pages
- 152-157
- ISSN
- 1070-5295 (ISSN-L)
- OpenAlex
- W1993079135
- Cited by
- 119
- References
- 70
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 4 · 2014: 2 · 2013: 4 · 2012: 7
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of General Medical Sciences (P50 GM 53789, R01-GM-58241, P50GM053789, R01GM058241)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- critical illness, intestinal motility, sepsis, open abdominal surgery, nitric oxide, prostaglandins, nitric oxide synthase, cyclooxygenase-2, macrophages, monocytes, local inflammatory response, muscularis, motor neurons
- MeSH terms
- Endotoxins, Humans, Intestinal Obstruction, Macrophages, Nitric Oxide, Postoperative Complications, Sepsis, Inflammation Mediators, Neurogenic Inflammation
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