Large bowel obstruction

Last reviewed: 30 May 2022
Last updated: 06 Oct 2021

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
More key diagnostic factors

Other diagnostic factors

  • tenesmus
  • history of radiotherapy
  • history of gynecologic symptoms
  • nausea and vomiting
  • groin swelling
  • pelvic mass
  • ingestion of foreign body
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum electrolytes
  • renal function
  • serum amylase/lipase
  • coagulation studies
  • plain abdominal x-ray
More 1st investigations to order

Investigations to consider

  • CT abdomen and pelvis
  • contrast enema
  • flexible/rigid endoscopy
  • biopsy
More investigations to consider

Treatment algorithm

INITIAL

acutely ill

ACUTE

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.

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