eMedicine Specialties > Gastroenterology > Colon

Colonic Obstruction: Follow-up

Author: Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Contributor Information and Disclosures

Updated: Jul 30, 2008

Follow-up

Further Inpatient Care

  • Resuscitation
  • Anatomic and, if possible, pathological characterization of the cause of the obstruction
  • Bowel cleansing if the obstruction is incomplete
  • Surgical relief of the obstruction
  • Dictated by the demands of postoperative convalescence

Further Outpatient Care

  • Care after discharge focuses on surgical convalescence and, if relevant, the need to care for the disease that caused the obstruction.
    • An obstructing colon cancer may require postoperative chemotherapy, depending on the stage of the disease.
    • The patient who is chronically obstipated may need stool softeners.
  • If the patient has received a colostomy or ileostomy, a decision regarding whether it is temporary or permanent may have been made at the time of discharge, depending on the patient's diagnosis, comorbidity, and postoperative convalescence.
  • Most patients who retain a rectum are, at least in principle, candidates for reanastomosis at a subsequent stage.
    • Generally, it is performed 2-3 months after the initial operation.
    • Careful counseling and assessment are required before proceeding with the second procedure.
    • Counseling is directed at the risks of the second procedure because the patient must understand that this surgery is elective and that a colostomy or ileostomy is compatible with a reasonable lifestyle. Often, local ostomy support groups and meeting with other patients with ostomies are helpful at this time.
    • Patients who had stool incontinence before their first operation, those with substantial surgical risks, and patients with decreased mental status who are cared for in nursing homes may potentially be better off without a reanastomosis.
    • In addition, the remaining colon, both proximally and distally, must be evaluated radiographically or endoscopically to rule out synchronous colonic lesions, such as neoplasms, because the presence of the large bowel obstruction prevented this from being performed before the first procedure.

Inpatient & Outpatient Medications

  • Pain medicines generally should be avoided preoperatively. If the pain is sufficiently severe to merit use of significant analgesics, peritonitis, rather than large bowel obstruction, should be considered as the first diagnosis.
  • Oral laxatives are contraindicated in patients with complete large bowel obstruction.
  • A slow preoperative mechanical bowel preparation is indicated for patients who have incomplete obstruction, provided the patient can tolerate it.
  • The author's preference is for polyethylene glycol solutions, such as GO-LYTELY, because they avoid issues of fluid and electrolyte imbalance. The fluid should be administered slowly (rather than given in the standard manner of 1 gal over 4 h), and the patient should be observed for abdominal cramping and intolerance.

Transfer

  • Transfer to another facility is indicated if adequate surgical management or backup is not available.
  • Prior to transfer, the patient should be adequately hydrated and resuscitated.

Deterrence/Prevention

  • Patients with an endoscopically reduced sigmoid volvulus should be offered elective surgical procedures, including sigmoid resection or fixation, because of the high risk of recurrence.
  • Aggressive screening for colorectal cancer in individuals who are older than 50 years or who have a strong family history of colorectal cancer, as indicated by current guidelines, should reduce the future incidence of malignant colonic obstruction.
  • See related CME at Guidelines Issued for Early Detection of Colorectal Cancer.

Complications

  • Peritonitis from bowel perforation secondary to overstrenuous attempts at reduction of volvulus or intussusception or injudicious attempts to dilate or stent an unsuitable colonic obstruction
  • Misdiagnosis of an ileus secondary to intra-abdominal infection as large bowel obstruction, with consequent delay in treatment
  • Intra-abdominal abscess from anastomotic leakage
  • Pneumonia from aspiration during emesis
  • Dehydration
  • Electrolyte disturbance

Prognosis

  • Prior to surgical decompression, the patient's overall medical condition and presence of any comorbidities that define surgical risk determine the prognosis.
  • After surgical decompression, prognosis is determined by the underlying disease.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize an incarcerated hernia as the cause of obstruction
  • Confusing large bowel obstruction with obstipation and managing it nonoperatively for a prolonged period
  • Confusing peritonitis and ileus with large bowel obstruction, resulting in delayed surgery
 


More on Colonic Obstruction

Overview: Colonic Obstruction
Differential Diagnoses & Workup: Colonic Obstruction
Treatment & Medication: Colonic Obstruction
Follow-up: Colonic Obstruction
References

References

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Further Reading

Keywords

colonic obstruction, colon obstruction, large bowel obstruction, bowel obstruction, obstructed bowels, volvulus, incarcerated hernia, stricture, obstipation, complete bowel obstruction, partial bowel obstruction, constipation, colostomy, ileostomy

Contributor Information and Disclosures

Author

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Medical Editor

Juan B Ochoa, MD, Assistant Professor, Department of Surgery, University of Pittsburgh
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

BS Anand, MD, Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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