Large Bowel Obstruction Introduction Obstruction can b

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Large Bowel Obstruction
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Introduction

• Obstruction can be defined by its site in
  relation to lumen
• Extramural
• Adhesions
• Volvulus
• Intramural
• Tumours
• Inflammation
• Luminal
• Impacted faeces
• Foreign body

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Introduction Continued

• Obstruction can be further defined by
• Site in intestine.
• Type- mechanical/non-mechanical
• Rate of onset
• Simple/strangulated/closed loop/partial/complete.

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Aetiology

• Carcinoma
• Diverticulitis
• Volvulus
• Megacolon and Faeces
• Adhesions and Herniation
• Pseudo-obstruction

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Clinical Findings

• Colicky pain
• Complete/incomplete constipation
• Faeculent Vomiting
• Weight loss, Appetite loss, Dehydration.
• On examination
• Distension of the abdomen
• Increased bowel sounds
• Tenderness (note if tender and distended over the
  caecum).
• Sucession Splash

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Investigations

• Bloods
• FBC
• UEs
• Amylase
• Group and Save
• CEA

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Investigations Continued

• X-rays
• Abnormal gas patterns
• Gas proximal to obstruction.
• Distended colon proximal to obstruction.
• Perforation- gas below diaphragm.

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X-Rays
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Investigation Continued

• Gastrographin Enema
• Imaging- sigmoidoscopy, Colonoscopy, CT scan.

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Imaging- CT
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Management

• IV resuscitation.
• Nasogastric tube- to decompress, and if vomiting
  to avoid aspiration.
• Analgesia
• Consider antibiotics as prophylaxis against
  sepsis.
• Surgical intervention- Laparotomy, Stenting,
  Resection.
• Sigmoidoscopy for Volvulus. 
• Conservative Treatment

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Course and Prognosis

• Prognosis depends on the cause of obstruction.
• Obstruction not associated with carcinoma (e.g.
  Diverticulitis) has a very good prognosis if
  treated.
• Complications
• Perforation
• Peritonitis