The Patient

When approaching a patient with ileus or obstruction, the most important therapeutic decision relates to the question whether or not emergent surgical intervention is necessary. Generally, a complete obstruction is a surgical emergency, especially if clinical findings or diagnostic studies indicate strangulation. However, operative interventions in these often severely ill individuals carry a high morbidity and mortality. This has led to the development of alternative approaches [10–12]. In the absence of complications, requiring immediate surgery, symptomatic therapy should be instituted in conjunction with appropriate diagnostic studies. The goal is to improve the overall performance status ofthe often very ill patient by alleviating pain and discomfort, correcting fluid and electrolyte abnormalities and decreasing the likelihood of complications due to intestinal distention. Intravenous access should be secured to replace fluid and electrolytes and to correct acid–base imbalances. Early decisions should be made about the need for nutritional support, as malnutrition contributes to excess morbidity and mortality in these patients [70,71]. Whenever possible the enteral route should be chosen, as nutrient flowing through the intestine decreases the likelihood of bacterial translocation and sepsis