Large bowel obstruction - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Large bowel obstruction is a surgical emergency which must be quickly differentiated from pseudo-obstruction to ensure that timely and correct treatment is provided. The classic signs and symptoms are abdominal pain, distention, vomiting, nausea, and absolute constipation but will depend on the underlying cause.
Consider malignancy in all patients who present with large bowel obstruction.
Initial workup involves laboratory tests and radiologic evaluation with abdominal play x-ray and computed tomography. After initial management to stabilize the patient, further intervention will depend on the underlying cause of obstruction and the patient's premorbid state and clinical status.
Suspect bowel perforation where there is persistent tachycardia, fever, and/or abdominal pain and tenderness.

Quick Reference

History & Exam
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Large bowel obstruction. Plain radiograph showing distended large bowel loops. Note grossly dilated caecum (white arrow)
Abdominal radiograph showing dilated large bowel loops. Typical "coffee bean'"sign seen for sigmoid volvulus

Citations

Key Articles

Alavi K, Poylin V, Davids JS, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colonic volvulus and acute colonic pseudo-obstruction. Dis Colon Rectum. 2021 Sep 1;64(9):1046-57.[Abstract][Full Text]
Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018 Aug 13;13:36.[Abstract][Full Text]
Naveed M, Jamil LH, Fujii-Lau LL, et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc. 2020 Feb;91(2):228-35.[Abstract]

Referenced Articles

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