Large Bowel Obstruction

Written by Mr. Panduka Jayawardena on 3 June 2021

Medically Reviewed by Dr. K on 14 June 2021

Large Bowel Obstruction

Large bowel obstruction is a mechanical interruption, either complete or partial to the flow of intestinal contents (4). Intestinal obstruction commonly accounts for up to 20% of admissions with acute abdominal pain (4). Colon cancer is the commonest cause of large bowel obstruction in adults (4).

Symptoms of Large Bowel Obstruction

Presenting features of bowel obstruction are abdominal pain, vomiting, abdominal distension, and absolute constipation (patient is unable to pass stool or flatus).
Suspicious prodromal features (early signs or symptoms of an illness or health problem that appear before the major signs or symptoms start) of colon cancer are anaemia, altered bowel habit, rectal bleeding, recent onset change in bowel habit and weight loss (1).

Risk Factors of Large Bowel Obstruction

Risk factors for bowel obstruction are colorectal adenomas or polyps, current or previous malignancy, inflammatory bowel disease, diverticular disease (can form strictures due to recurrent inflammation), current or previous hernia, previous abdominal surgery, and radiotherapy (both can form scar tissue).

Diagnosis of Large Bowel Obstruction

The patient will undergo an urgent CT abdomen and pelvis with contrast if thought to be having an obstruction (2). CT is fairly accurate in determining partial versus complete obstruction and it is useful to identify possible causes of obstruction and early signs of ischemic changes (3).

Plain abdominal XR showing large bowel obstruction. Image sourced from (4).

CT scan in the same patient showing a transition point at the splenic flexure due to an obstruction. Image sourced from (4)

Treatment of Large Bowel Obstruction

Large bowel obstruction is a true surgical emergency requiring immediate treatment. The patient will be resuscitated with intravenous fluids (usually dehydrated due to vomiting and third space loss), nasogastric intubation and aspiration, analgesia, and antibiotics if septic due to bacterial translocation (4).

Source:

Referenced on 3 June 2021

  1. Lynch B, Sarazine J. A guide to understanding malignant bowel obstruction. Int J Palliat Nurs. 2006 Apr;12(4):164-6, 168-71.
  2. Finan PJ, Campbell S, Verma R, et al. The management of malignant large bowel obstruction: ACPGBI position statement. Colorectal Dis. 2007 Oct;9 Suppl 4:1-17.
  3. Thompson JS. Contrast radiography and intestinal obstruction. Ann Surg. 2002;236(1):7-8. doi:10.1097/00000658-200207000-00003
  4. Griffiths, S. and Glancy, D.G. (2020). Intestinal obstruction. Surgery (Oxford), 38(1), pp.43–50.

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