Postoperative ileus is often viewed as a common complication after radical cystectomy, which delays eating, prolongs hospital stay, and affects the overall recovery journey for both patients and clinicians. But what if ileus is doing more than that? While acute kidney injury (AKI) after surgery is usually linked to hypotension, hypovolaemia, or nephrotoxic medications, we believe that there is another important factor that should be looked at more closely.

In this narrative article, we explore how progressive abdominal distension secondary to postoperative ileus can increase intra-abdominal pressure, compromising renal perfusion and glomerular filtration through a series of interconnected physiological mechanisms. By linking physiology with a realistic clinical scenario, we wanted to encourage clinicians to think beyond isolated complications and instead recognise how one postoperative event can set off a cascade of others.

We chose to write this article because perioperative complications rarely occur in isolation. Understanding the links between complications allows us to move beyond treating individual problems and instead adopt a more integrated approach. Our review highlights practical perioperative strategies that may interrupt this cascade before kidney injury develops. We hope this review encourages clinicians to think differently about postoperative ileus and inspires further research into strategies that improve outcomes for patients undergoing major urological surgery

Pathophysiological links between postoperative ileus and acute kidney injury after cystectomy by Nora Cruz Rodriguez (University College London; Cleveland Clinic London, UK), Rosalyn Hawkins (University College London Hospitals, UK), John Whittle (University College London Hospitals, UK) is published in Advances in Perioperative Care, volume 1.

Nora Cruz Rodriguez is an anaesthetist from Mexico with a strong interest in perioperative medicine and cardiovascular anaesthesia. She moved to the United Kingdom to undertake a fellowship in perioperative medicine within the NHS, where she has been involved in clinical care, research, education, and quality improvement initiatives focused on optimising outcomes for high-risk surgical patients. She is currently completing an MSc in Perioperative Medicine at University College London and is working towards becoming a consultant anaesthetist in the UK.

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