Snap Shot A 65 yo presents with abdominal distension and colicky pain. Introduction Adhesions are the most common cause of all bowel obstructions. Colon cancer is the most common cause in elderly people accounts for 15% of obstructions Sigmoid most common site. Causes include: adhesions adenocarcinoma divirticulitis scaring volvulus Presentation Symptoms constipation nausea/vomiting Physical exam abdominal distension surgical scars high pitched "tinkly" bowel sounds tenderness hernias Evaluation Abdominal X-ray distended proximal colon with haustra air-fluid levels no gas in rectum Consider barium enema do NOT give orally Differential Pseudo-obstruction (Ogilvie's Syndrome) Treatment Hospitalize Nasogastric decompression NPO Rehydrate Rectal tube Surgery: Emergency X-lap: if cecal diameter > 12 cm peritonitis sepsis free air Gangrenous colon requires partial colectomy with diverting colostomy unless all bowel is well perfused at surgery.