Large bowel obstruction

Large bowel obstruction is a surgical emergency which must be quickly differentiated from pseudo-obstruction to ensure that timely and correct treatment is provided. The classic signs and symptoms are abdominal pain, distention, vomiting, nausea, and absolute constipation but will depend on the underlying cause.

Consider malignancy in all patients who present with large bowel obstruction.

Initial workup involves laboratory tests and radiologic evaluation with abdominal plain x-ray and computed tomography. After initial management to stabilize the patient, further intervention will depend on the underlying cause of obstruction and the patient’s premorbid state and clinical status.

Suspect bowel perforation where there is persistent tachycardia, fever, and/or abdominal pain and tenderness.

Surgical emergency where a mechanical interruption (either complete or partial) occurs to the flow of intestinal contents, with multiple potential causes (e.g., malignant colorectal disease, colonic volvulus, benign stricture). This topic covers acquired obstruction in adults.