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
George Malietzis, MBBS, MSc, MRCS, PhD
Colorectal Registrar
Department of Coloproctology
St Mark's Hospital
London
UK
Disclosures
GM declares that he has no competing interests.
John T. Jenkins, MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
Disclosures
JTJ declares that he has no competing interests.
Acknowledgements
Dr George Malietzis and Dr John T. Jenkins would like to gratefully acknowledge Dr Alisdair J. MacDonald, a previous contributor to this topic. AJM declares that he has 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
- Chronic/idiopathic megacolon
- Toxic megacolon
More DifferentialsGuidelines
- Clinical practice guidelines for colon volvulus and acute colonic pseudo-obstruction
- 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation
More GuidelinesPatient leaflets
Bowel cancer
Bowel cancer: questions to ask your doctor
More Patient leafletsVideos
Venepuncture and phlebotomy: animated demonstration
Central venous catheter insertion: animated demonstration
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer