Molecular and Cellular Inflammatory Mechanisms in the Development of Postoperative Ileus

Iatrogenic postoperative ileus occurs almost inevitably following abdominal surgery. Various pathogenic mechanisms have been investigated and the pathophysiology appears to be multifactorial with neurogenic, inflammatory, and pharmacological mechanisms all contributing to this clinical conundrum. In fact, recent data suggest a synergistic interplay between the various mechanisms. Early manifestations of postoperative ileus most likely have a strong neurogenic component, but the prolonged clinical phenomenon is probably primarily caused by the generation of a local molecular and cellular inflammatory response within the immunologically active muscularis externa of the surgically manipulated gastrointestinal tract. Also, important in understanding this disorder is delineating the natural anti-inflammatory pathways that restore the bowel to normal function and the therapeutic potential of preemptively modulating this pathway.