Approach

Urgent surgical consultation is required for any patient with suspected large bowel obstruction. Signs and symptoms depend on the underlying cause; therefore, a thorough physical examination is important. Patient age and onset of symptoms (gradual vs. abrupt) guides diagnosis of the underlying cause.

Initial work-up involves laboratory tests and an erect chest x-ray to assess for intestinal perforation. Diagnosis of obstruction is confirmed by colonic dilation on plain abdominal x-ray. Contrast enema or abdominal/pelvic computed tomography (CT) confirms diagnosis of obstruction where doubt exists on x-ray, and CT may also indicate the underlying cause (e.g., malignancy, colonic volvulus, stricture, diverticulitis).[17] Department of Health Western Australia: diagnostic imaging pathways - bowel obstruction (suspected) external link opens in a new window Endoscopy and biopsy confirm a diagnosis of malignancy, although this is frequently not achievable and may be inappropriate in the emergency situation.

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