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