Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Oct 1 2019

Large Bowel Obstruction

  • Snapshot
    • An 80-year-old man with a history of divertulosis and multiple episodes of diverticulitis presents to the emergency room for increasing crampy abdominal pain, nausea, and vomiting. He last had a bowel movement 4 days ago and has had tiny amounts of diarrhea. He has not had any flatus since last night. On physical exam, his abdomen is noted to be distended, somewhat rigid, and tender to palpation. Bowel sounds are absent. A digital rectal exam reveals hard stool in the rectal vault. An abdominal radiograph shows dilated loops of bowel but no free air under the diagphragm. A computed tomography of his abdomen and pelvis confirms the presence of dilated loops of bowel and a large fecolith.
  • Introduction
    • Overview
      • large bowel obstruction, or LBO, is a surgical emergency and requires intervention
        • obstruction may be partial or complete
        • complete obstructions require immediate surgical intervention
    • Epidemiology
      • demographics
        • elderly patients
      • etiology
        • volvulus
        • intussusception
        • colonic mass/malignancy
        • diverticular disease
        • fecal impaction
        • stricture
        • incarcerated hernia
      • risk factors
        • chronic constipation
    • Pathogenesis
      • mechanism
        • mechanical obstruction in the large bowel causes bowel dilatation above the point of obstruction causes
          • bowel edema and ischemia
          • electrolyte abnormalities
    • Prognosis
      • prognostic variable
        • if treated early, mortality for LBO is low
        • if there is bowel ischemia or perforation, mortality is higher
  • Presentation
    • History
      • chronic constipation
      • lack of flatus
        • indicates complete obstruction
        • some passage of flatus or stool
          • indicates partial obstruction
    • Symptoms
      • crampy abdominal pain
      • nausea and vomiting
      • bloating
    • Physical exam
      • inspection
        • abdominal distention
      • motion
        • tenderness to palpation
        • abdominal rigidity
        • quiet or absent bowel sounds
      • provocative tests
        • digital rectal exam
          • may reveal hard stool in the rectal vault
  • Imaging
    • Abdominal radiographs
      • indications
        • all patients
        • screen for free air under the diaphragm
      • views
        • flat
        • upright
      • findings
        • dilated bowel
    • Contrast radiography with enema
      • indication
        • if CT findings are equivocal and volvulus is suspected
      • findings
        • “bird’s beak” appearance
    • Computed tomography (CT) of abdomen and pelvis with contrast
      • indications
        • imaging of choice for diagnosis of LBO
        • distinguishes between a partial or complete obstruction
      • findings
        • mechanical obstruction identified
        • dilated loops of bowel
      • contrast agent
        • gastrografin should be used if bowel perforation is suspected
  • Studies
    • Serum labs
      • basic metabolic panel
        • to correct any electrolyte abnormalities
      • lactate
        • to evaluate for bowel ischemia
      • complete blood cell count
        • white blood cells are only mildly elevated
  • Differential
    • Small bowel obstruction
      • key distinguishing factor
        • dilated loops of small bowel seen on imaging rather than dilated loops of large bowel
    • Ogilvie syndrome
      • key distinguishing factor
        • no mechanical lesion on CT imaging that can cause the obstruction
  • Treatment
    • Lifestyle
      • modified diet
        • indications
          • for patients with history of obstruction
        • modalities
          • high-fiber diet
          • stool softeners
    • Medical
      • observation and bowel rest
        • indications
          • mild symptoms without vomiting
        • modalities
          • intravenous fluids
          • correct electrolyte abnormalities
      • nasogastric decompression and bowel rest
        • indications
          • abdominal distention
          • vomiting
    • Surgical
      • exploratory laparotomy
        • indications
          • complete LBO
          • bowel ischemia
          • volvulus
  • Complications
    • Ischemic colitis
    • Bowel perforation
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options