eMedicine Specialties > Gastroenterology > Colon

Colonic Obstruction: Treatment & Medication

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

Updated: Jul 30, 2008

Treatment

Medical Care

  • Medical care of colonic obstruction involves resuscitation, correction of the fluid and electrolyte imbalance, and nasogastric decompression to temporarily treat the obstruction and to prevent vomiting and aspiration.
  • Medical care is directed primarily at supporting the patient and treating any comorbid illnesses.
  • For a small subset of patients, in whom the obstruction not only is malignant but also reflects substantially disseminated or even inoperable disease, consideration of completely nonoperative palliative therapy within the context of a palliative care or hospice approach may be appropriate. This might include somatostatin therapy and may or may not include nasogastric decompression.4

Surgical Care

  • Surgical care is directed at relieving the obstruction.
  • In most patients, the obstructing lesion is resected.
    • Because the colon has not been cleansed, anastomosis often is risky.
    • After resection, most surgeons perform a proximal colostomy if the obstruction is on the left side or ileostomy if it is on the right side.
  • In patients with substantial comorbidity and surgical risk or in the presence of an unresectable tumor, a diverting proximal colostomy or ileostomy may be performed without resection.
  • A diverting transverse loop colostomy may be the least invasive procedure for a very ill patient with a left colonic obstruction. It permits relief of the obstruction and further resuscitation without compromising chances for a subsequent resection. A recent case report describes the use of hand-assisted laparoscopy via the loop colostomy site for subsequent resection of the obstructing lesion.5
  • A sigmoid colostomy without resection may be used in patients with a rectal obstruction that cannot be managed without a combined abdominoperineal approach.
  • Cecostomy should not be performed because the diversion is inadequate.
  • In younger patients without substantial comorbidity, some surgeons would consider primary anastomosis, rather than ileostomy, in the right colon, assuming no intraoperative hypotension, blood loss, or other complications are present.
  • If resection and proximal colostomy or ileostomy are performed, a mucous fistula generally is extracted from the distal end, unless the obstruction is rectosigmoid, in which case the distal end may be oversewn or stapled and left to drain transanally.
  • If the cause of the obstruction can be relieved nonsurgically, through procedures such as decompressing a volvulus, or if the obstruction is only partial, deferring surgery temporarily and supporting the patient while the large bowel is cleansed so that primary anastomosis may be performed more safely is preferable.

Consultations

  • Gastroenterologist or surgeon for assessment and probable endoscopy

Diet

  • Patients with complete large bowel obstruction should receive nothing by mouth.
  • Patients with a partial obstruction may tolerate minimal clear liquids, oral medications, and a gradual bowel preparation.

Medication

Oral laxatives are contraindicated if large bowel obstruction is suspected. If any evidence suggests simple constipation, patients should be managed with transrectal enemas. Tap water, isotonic sodium chloride solution, and a variety of other fluids may be used. In patients with renal insufficiency, the physician should be sensitive to the electrolyte content of the fluid.

More on Colonic Obstruction

Overview: Colonic Obstruction
Differential Diagnoses & Workup: Colonic Obstruction
Treatment & Medication: Colonic Obstruction
Follow-up: Colonic Obstruction
References
[ CLOSE WINDOW ]

References

  1. Nagata K, Ota Y, Okawa T, et al. PET/CT colonography for the preoperative evaluation of the colon proximal to the obstructive colorectal cancer. Dis Colon Rectum. Jun 2008;51(6):882-90. [Medline].

  2. Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc. Mar 2008;67(3):478-88. [Medline].

  3. van Hooft JE, Fockens P, Marinelli AW, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. Mar 2008;40(3):184-91. [Medline].

  4. Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. May 2008;44(8):1105-15. [Medline].

  5. Mukai M, Tanaka A, Tajima T, et al. Two-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by left colon cancer: a case report. Oncol Rep. Apr 2008;19(4):875-9. [Medline].

  6. Caceres A, Zhou Q, Iasonos A, et al. Colorectal stents for palliation of large-bowel obstructions in recurrent gynecologic cancer: an updated series. Gynecol Oncol. Mar 2008;108(3):482-5. [Medline].

  7. De Giorgio R, Stanghellini V, Barbara G, et al. Prokinetics in the treatment of acute intestinal pseudo-obstruction. IDrugs. 2004/02;7(2):160-5.

  8. de Gregorio MA, Mainar A, Tejero E, et al. Acute colorectal obstruction: stent placement for palliative treatment--results of a multicenter study. Radiology. Oct 1998;209(1):117-20. [Medline].

  9. Deen KI, Madoff RD, Goldberg SM, et al. Surgical management of left colon obstruction: the University of Minnesota experience. J Am Coll Surg. Dec 1998;187(6):573-6. [Medline].

  10. Fan YB, Cheng YS, Chen NW, et al. Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction. World J Gastroenterol. Feb 7 2006;12(5):755-9. [Medline].

  11. Forloni B, Reduzzi R, Paludetti A, et al. Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum. Jan 1998;41(1):23-7. [Medline].

  12. Isbister WH, Prasad J. Emergency large bowel surgery: a 15-year audit. Int J Colorectal Dis. 1997;12(5):285-90. [Medline].

  13. Lopez-Kostner F, Hool GR, Lavery IC. Management and causes of acute large-bowel obstruction. Surg Clin North Am. Dec 1997;77(6):1265-90. [Medline].

  14. Losanoff JE, Basson MD. Amyand hernia: what lies beneath--a proposed classification scheme to determine management. Am Surg. Dec 2007;73(12):1288-90. [Medline].

  15. Reemst PH, Kuijpers HC, Wobbes T. Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis. Eur J Surg. Jul 1998;164(7):537-40; discussion 541-2. [Medline].

  16. Sakorafas GH, Peros G. Obstructing sigmoid cancer in a patient with a large, tender, non-reducible inguinal hernia: the obvious diagnosis is not always the correct one. Eur J Cancer Care (Engl). Jan 2008;17(1):72-3. [Medline].

  17. Schermer CR, Hanosh JJ, Davis M, et al. Ogilvie's syndrome in the surgical patient: a new therapeutic modality. J Gastrointest Surg. Mar-Apr 1999;3(2):173-7. [Medline].

  18. [Best Evidence] Sgouros SN, Vlachogiannakos J, Vassiliadis K, et al. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut. May 2006;55(5):638-42. [Medline].

  19. Stefanidis D, Brown K, Nazario H, et al. Safety and efficacy of metallic stents in the management of colorectal obstruction. JSLS. Oct-Dec 2005;9(4):454-9. [Medline].

  20. Suri S, Gupta S, Sudhakar PJ, et al. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol. Jul 1999;40(4):422-8. [Medline].

  21. Turegano-Fuentes F, Echenagusia-Belda A, Simo-Muerza G, et al. Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon. Br J Surg. Feb 1998;85(2):232-5. [Medline].

  22. Turegano-Fuentes F, Munoz-Jimenez F, Del Valle-Hernandez E, et al. Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment. Dis Colon Rectum. Nov 1997;40(11):1353-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.