Large bowel obstruction
小结
定义
病史和体格检查
关键诊断因素
- colicky abdominal pain
- abdominal distention
- nausea
- vomiting
- change in bowel habits
- hard feces
- soft stools
- empty rectum
- recent weight loss
- rectal bleeding
- palpable rectal mass
- palpable abdominal mass
- tympanic abdomen
- abnormal bowel sounds
- fever
- abdominal tenderness
- abdominal rigidity
其他诊断因素
- tenesmus
危险因素
- colorectal cancer
- current or previous malignancy
- diverticular disease
- colonic volvulus
- inflammatory bowel disease
- current or previous hernia
- endometriosis
- diabetes
- previous abdominal surgery
- megacolon
- low or high dietary fiber
- laxative abuse
- previous radiation therapy
- ingestion of foreign body
诊断性检查
首要检查
- CT abdomen and pelvis
- CBC
- serum electrolytes
- CRP
- renal function
- glucose
- coagulation studies, type and screen, cross-match
- blood gas analysis (including lactate)
- serum amylase/lipase
- plain abdominal x-ray
需考虑的检查
- beta-human chorionic gonadotrophin
- urinalysis
- abdominal ultrasound
- contrast enema
- flexible/rigid endoscopy
- biopsy
治疗流程
acutely ill
sigmoid volvulus
cecal volvulus
colorectal malignancy
diverticular disease
foreign body ingestion
benign strictures
pelvic abscess
currently receiving palliative care
撰稿人
专家顾问
Adrian A. Maung, MD, MBA, FACS, FCCM
Associate Professor of Surgery
Division of General Surgery, Trauma and Surgical Critical Care
Department of Surgery
Yale School of Medicine
Surgical Director of Perioperative Services
Adult Trauma Medical Director
Yale New Haven Hospital
New Haven
CT
利益声明
AAM declares that he has no competing interests.
鸣谢
Dr Adrian A. Maung would like to gratefully acknowledge Dr George Malietzis, Dr John T. Jenkins, and Dr Alisdair J. MacDonald, previous contributors to this topic.
利益声明
GM, JTJ, and AJM declare that they have no competing interests.
同行评议者
Alessandro Fichera, MD, FACS, FASCRS
Assistant Professor
Department of Surgery
University of Chicago
Chicago
IL
利益声明
AF declares that he has no competing interests.
Robert H. Diament, MD
Consultant Surgeon
Crosshouse Hospital
Crosshouse
Kilmarnock
UK
利益声明
RHD declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
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.全文 摘要
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.全文 摘要
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. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Acute colonic pseudo-obstruction (Ogilvie syndrome)
- Chronic/idiopathic megacolon
- Toxic megacolon
更多 鉴别诊断指南
- WSES consensus guidelines on sigmoid volvulus management
- 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation
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