Large bowel obstruction
Summary
Definition
History and exam
Key diagnostic factors
- intermittent abdominal pain
- abdominal distention
- nausea
- vomiting
- change in bowel habit
- presence of risk factors
- hard faeces
- soft stools
- empty rectum
- recent weight loss
- rectal bleeding
- palpable rectal mass
- palpable abdominal mass
- tympanic abdomen
- fever
- abdominal tenderness
- abdominal rigidity
Other diagnostic factors
- tenesmus
Risk factors
- colorectal adenomas or polyps
- current or previous malignancy
- inflammatory bowel disease
- diverticular disease
- current or previous hernia
- gynaecological conditions
- diabetes
- previous abdominal surgery
- previous radiotherapy
- family history of bowel cancer
- age
- male sex
- obesity
- megacolon
- laxative abuse
- diet
- alcohol consumption
- smoking
Diagnostic investigations
1st investigations to order
- computed tomography
- full blood count
- electrolytes
- C-reactive protein
- urea/creatinine ratio
- glucose
- clotting, group and save, or cross-match
- arterial blood gas (including lactate)
Investigations to consider
- beta-human chorionic gonadotrophin
- urinalysis
- electrocardiogram
- water-soluble contrast study
- lower gastrointestinal endoscopy or flexible sigmoidoscopy
Treatment algorithm
suspected or impending perforation
malignancy
volvulus
benign strictures
diverticular disease
currently receiving palliative care
Contributors
Expert advisers
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Disclosures
JA is trustee and council member of the Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
George Malietzis, MBBS, MSc, MRCS
Colorectal Registrar
Department of Coloproctology
St Mark's Hospital
London
UK
John T. Jenkins, MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
Peer reviewers
Ceri Beaton, BMedsci, BMBS, MSc, FRCS
Consultant Colorectal and General Surgeon
North Devon Healthcare NHS Trust
Devon UK
Disclosures
CB declares that she has no competing interests.
Editors
Emma Quigley,
Section Editor, BMJ Best Practice
Disclosures
EQ declares that she has no competing interests.
Tannaz Aliabadi-Oglesby,
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Sue Mayor,
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Annabel Sidwell,
Comorbidities Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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