The AAO Journal, 2014/06, 24(2):24, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://www.academyofosteopathy.org/aaoj)

Keywords:

postoperative ileus [3]
bowel disease [14]
female [655]
women [608]
adolescent [83]
case report [736]
conference abstract [127]

Abstract:

Introduction: Postoperative ileus refers to the failure to pass gas or stools and intolerance of oral intake due to disruption of the normal propulsive activity of the gastrointestinal tract during the postoperative period. Postoperative ileus may lead to increased patient pain and discomfort while prolonging the duration of hospital stays.2 Multiple pathophysiologic mechanisms contribute to postoperative ileus. The success of treatment remains limited due to the complexity of neurologic and inflammatory control of gastrointestinal function. Despite the huge cost associated with postoperative ileus, there have been very few medical advances for treating patients for postoperative ileus. Case Description: A 17-year-old Hispanic female patient post laparoscopic appendectomy complained of a bloating sensation, and she confirmed that she had not had a bowel movement. Osteopathic examination revealed hypertonic paraspinal musculature in the thoracic and lumbar spines and diffuse bogginess of the abdomen. Osteopathic manipulative treatment (OMT) techniques were selected to impact each component of the complex pathophysiology of postoperative ileus. These techniques included suboccipital release, ribless rib raising, myofascial technique, and mesenteric lifts. Twenty minutes following treatment with OMT, the patient reported having a bowel movement. Discussion: Inhibitory neural reflexes are believed to have local action via noxious spinal afferents, which increase inhibitory sympathetic activity.1 OMT was used to help normalize the autonomic nervous system (ANS) with the rib/ribless rib raising techniques. Intestinal manipulation and trauma lead to macrophage activation and an inflammatory response, slowing motility.1 This was addressed with OMT to help normalize the ANS with suboccipital release. Neurohumoral peptides such as nitric oxide, vasoactive intestinal peptide, and possibly substance P are also thought to slow transit time in the gut.4 This was addressed with OMT by providing myofascial release to the thoracic and lumbar spines. OMT helps remove structural restriction to lymph flow and promote lymphatic flow.3 The mesenteric lift technique was used to decrease venous congestion and decrease inflammation of the gut. Conclusion: This case illustrates the effectiveness of OMT in a postoperative ileus case. Consideration should be given to the role of OMT as an adjuvant approach to mainstay therapies for treating patients for postoperative ileus.