Large bowel obstruction
Summary
Definition
History and exam
Key diagnostic factors
- colicky abdominal pain
- abdominal distention
- tympanic abdomen
- change in bowel habits
- hard feces
- empty rectum
- soft stools
- recent weight loss
- rectal bleeding
- abnormal bowel sounds
- palpable rectal mass
- palpable abdominal mass
- positive fecal occult blood test
- fever
- abdominal tenderness
- abdominal rigidity
Other diagnostic factors
- tenesmus
- history of radiotherapy
- history of gynecologic symptoms
- nausea and vomiting
- groin swelling
- pelvic mass
- ingestion of foreign body
Risk factors
- older age
- female sex
- institutionalization
- mental illness
- megacolon
- low or high dietary fiber
- previous colorectal resection
- previous abdominal surgery
- inflammatory bowel disease
- laxative abuse
- diabetes
Diagnostic investigations
1st investigations to order
- CBC
- serum electrolytes
- renal function
- serum amylase/lipase
- coagulation studies
- plain abdominal x-ray
Investigations to consider
- CT abdomen and pelvis
- contrast enema
- flexible/rigid endoscopy
- biopsy
Treatment algorithm
acutely ill
sigmoid volvulus
cecal volvulus
colorectal malignancy
diverticular disease
foreign body ingestion
benign strictures
endometriosis
pelvic abscess
Contributors
Authors
Adrian A. Maung, MD, 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
Disclosures
AAM declares that he has no competing interests.
Acknowledgements
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.
Disclosures
GM, JTJ, and AJM declare that they have no competing interests.
Peer reviewers
Alessandro Fichera, MD, FACS, FASCRS
Assistant Professor
Department of Surgery
University of Chicago
Chicago
IL
Disclosures
AF declares that he has no competing interests.
Robert H. Diament, MD
Consultant Surgeon
Crosshouse Hospital
Crosshouse
Kilmarnock
UK
Disclosures
RHD declares that he has no competing interests.
Differentials
- Acute colonic pseudo-obstruction (Ogilvie syndrome)
- Small bowel obstruction
- Chronic/idiopathic megacolon
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