Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature an
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. Jaber1 · S. Hemmer1 · R. Klotz2 · T. Ferbert1 · C. Hensel1 · C. Eisner3 · Y. M. Ryang4 · P. Obid5 · K. Friedrich6 · W. Pepke1 · M. Akbar7 1
© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020
Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany 2 Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany 3 Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Heidelberg, Germany 4 Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany 5 Spinal Surgery and Scoliosis Centre, Asklepios Paulinen Clinic, Wiesbaden, Germany 6 Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany 7 MEOCLINIC GmbH, Berlin, Germany
Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital Background The medical literature is rich with highquality studies that address the issue of chronic neurogenic bowel dysfunction after spinal cord injury (SCI) [1]. Secondary health problems in patients who incur SCI include chronic constipation or neurogenic bowel dysfunction as a major problem. After loss of mobility [2], bowel dysfunction is recognized by afflicted individuals and caregivers as a lifelong physical and psychological challenge that profoundly affects the quality of life [3]. Planned spinal procedures generally have a significant risk for acute phase of bowel dysfunction postoperatively [4, 5]. This problem is not expected and often underestimated. Since SCI or pre-existing causes of bowel dysfunction are not present in these patients, a full recovery is expected. Acute bowel dysfunction is usually self-limiting and benign; however, it can become prolonged and might even lead to fatal complications [6]. In the inpatient setting it is important to dif-
ferentiate SCI with chronic neurogenic bowel dysfunction from acute bowel dysfunction seen postoperatively without an existing SCI. This is hardly a problem of spinal surgery alone but can occur in after a wide variety of orthopedic procedures that may lead to postoperative pain and immobility. The incidence of ileus following lower extremity arthroplasty has been reported between 0.3% and 4% after primary arthroplasty and up to 5.6% after revision surgery [7]. Overall, postoperative bowel dysfunction occurs in approximately 3.5% of patients following surgery to the lumbar spine [4]. In specific spinal interventions, the incidence may reach up to 9.2%. In a retrospective study, Lee et al. reviewed data of 612 patients who suffered from severe constipation following orthopedic surgery. A significant difference in the incidence of postoperative ileus was seen. Patients who underwent limb surgery were 90% less likely to develop ileus than those who underwent spinal surgery [5]. Mandl et al. conducted a case-control study
and analyzed 273 patients who s
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