Large bowel obstruction

• It is an emergency condition that requires early identification and intervention.
• Acute Vs chronic
• Complete vs Partial
• Mechanical vs pseudo-obstruction

Symptoms:

• Crampy abdominal pain
• Abdominal distention
• Nausea and vomiting

Other symptoms that may be diagnostically significant include the following:

• Abrupt onset of symptoms (acute obstruction)
• Recurrent left lower quadrant abdominal pain over several years (suggestive of diverticulitis, a diverticular stricture)
• Chronic constipation, long-term cathartic use, and straining at stools (diverticulitis or carcinoma)
• Changes in stool caliber (suggestive of carcinoma)

Signs:

• Abdomen (inspection, auscultation, percussion, and palpation)
• Evaluate bowel sounds, tenderness, rigidity, guarding, and any mass or fullness
• Inguinal and femoral regions, look for a possible incarcerated hernia
• Rectum, contents of anal vault, and stool consistency; perform fecal occult blood testing as appropriate

Etiology:

• Neoplasm* (benign or malignant) 60%
• Stricture (diverticular or ischemic)
• Volvulus (colonic, sigmoid, cecal) 5%
• Fecal Impaction

Diagnosis

Labs:

• Complete blood count (CBC) : WBC, HB, Hematocrit
• Coagulation
• Electrolytes
• LFT
• Serum lactate (if bowel ischemia is a consideration)
• Urinalysis
• Stool guaiac test

Diagnosis

Radiology Imaging

• Plain radiography (flat and upright)
• Contrast radiography with enema

Computed tomography (CT) –

• This is the imaging modality of choice

Colonoscopy/Bx

Management

Initial therapy

• Volume resuscitation
• Appropriate preoperative broad-spectrum antibiotics
• Timely surgical consultation
• Consideration of a nasogastric tube for severe colonic distention and vomiting

The following are emergencies that call for surgical intervention:

• Closed loop obstructions

• Sepsis due to complicated diverticular disease
• Bowel ischemia
• Volvulus

Supportive measures:

• Nil By Mouth
• Intake- output charts
• IV lines, and rehydration (IV crystalloid with K+)
• Foley’s catheter
• NG Tube to aspirate content for ‘decompression’
• TED stockings, DVT prophylaxis
• Antibiotics
• Antiemetics
• Analgesia

Surgery:

Closed loop obstructions, Sepsis, Bowel ischemia, Volvulus