How do you induce passing gas post-op?

[bjaeram]

So it's 12 days since surgery to remove a bladder and make a new one from intestine. Still no gas, nausea with the littlest bit of oral intake. Is this ever normal? The doctor doesn't seem concerned and just wants to wait. I'm concerned the patient is frustrated and was supposed to be home already. Xray shows ileus. Otherwise healing well from surgery. Are there any tricks to get things moving other then moving. He does walk the halls a lot already.

[AtomicWoman]

This is unfortunately a common side effect of substitution cystectomy. 12 days is way too long. That surgeon better get concerned asap, esp. w/an ileus.

Here's the abstract of an article that recommends post-op enteral or total parenteral feeding to get things moving:

http://www.ncbi.nlm.nih.gov/pubmed/17962014

Note the median return to BM was 2 days and return to a regular diet was 4 days.

12 days? I'd be worried.

[RNKPCE]

This is not just simple passing gas a couple days post op. I would hope a lot of the suggestions have already been done.

A family member had an ileus recently and had a therapeutic colonoscopy done to release air. Never seen that done before but it worked.

[nurseprnRN, BSN, RN]

Patient diabetic with hypomobility issues preop? How long does the surgeon want to go before reinstituting whatever they did before? If not...

Yep, time to call the surgeon and make him/her explain why the NIH says average 4 days to normal oral intake is expected and this patient is sitting at twelve days and counting. Print out that paper and attach it to the chart so s/he knows you've all read it.

[Sean 91]

I think you want allphysicians.com

The case manager must be going nuts after 12 days, not to mention the doctors--can't believe they are "unconcerned." Insurance and/or Medicare funds must be running low. Haven't seen any mention of ambulation. Walk, walk, walk. Out of bed TID. GI docs like Reglan, as mentioned above, for GI stimulation as well as anti-nausea. Nausea at slightest PO intake? Must be on Procal and Lipids at this point if not keeping anything down--would be clear liquids still, if not NPO. What do the KUB/US/XR abd show? How's the surgical site look? Infection? Fevers? Have there been an EGD/colonoscopy in the recent past? Swallow eval by speech? TAKING NARCOTICS for pain, which is causing constipation? Stool softeners? On IV fluids and are the electroyte levels normal? Chewing gum as someone said above, but that's in the literature, haven't seen much in the hospital.

[bjaeram]

CT scan today just showed continued ileus. Some minor diarrhea yesterday but none today. The smallest sips of liquid cause a full feeling and nausea. Healing well otherwise. Taking minimal morphine at this point. No infection. No preexisting conditions except some hypertension. The doctor still does not remain concerned and just says it takes longer in some people then others. The only thing done today was order a PT consult. pt has been ambulating well. He had an NG tube last week for a couple of days that really helped the nausea but it fell out and was not ordered to be replaced. This doctor doesn't seem to get concerned about anything......He did have a significant amount of bleeding during the surgery that required transfusion and extra manipulation of the bowels. Could that be playing a part?

I'll suggest some of the things here. Thanks for the advice!