Overview
What is large-bowel obstruction (LBO)?
Which history is characteristic of large-bowel obstruction (LBO)?
What are the signs and symptoms of large-bowel obstruction (LBO)?
What should be assessed in the evaluation of large-bowel obstruction (LBO)?
What should be the focus of the physical exam for large-bowel obstruction (LBO)?
Which lab studies are included in the evaluation of large-bowel obstruction (LBO)?
Which imaging modalities included in the evaluation of large-bowel obstruction (LBO)?
What is the initial management of large-bowel obstruction (LBO)?
When is emergency surgical intervention indicated for large-bowel obstruction (LBO)?
How is ileus treated in large-bowel obstruction (LBO)?
How is acute colonic pseudo-obstruction treated?
How is volvulus in large-bowel obstruction (LBO)?
How is intussusception treated in large-bowel obstruction (LBO)?
How are colonic masses and strictures treated in large-bowel obstruction (LBO)?
How is diverticular disease treated in large-bowel obstruction (LBO)?
What causes large-bowel obstruction (LBO)?
Why is it important to distinguish colonic obstruction from ileus in large-bowel obstruction (LBO)?
How does the etiology of large-bowel obstruction (LBO) vary by age?
What are the risk factors for large-bowel obstruction (LBO)?
What is the pathophysiology of mechanical large-bowel obstruction (LBO)?
What is the pathophysiology of acute colonic pseudo-obstruction (ACPO)?
What causes large-bowel obstruction (LBO)?
How do neoplasms and diverticular disease cause large-bowel obstruction (LBO)?
How does volvulus cause large-bowel obstruction (LBO)?
Which patients are at highest risk for volvulus-related large-bowel obstruction (LBO)?
What is the prevalence and cause of intussusception in adults?
What is enterocolic intussusception?
What is colocolic intussusception?
What is acute colonic pseudo-obstruction (Ogilvie syndrome)?
What is the prognosis of large-bowel obstruction (LBO)?
What is the mortality rate of acute colonic pseudo-obstruction (ACPO; Ogilvie syndrome)?
Presentation
What should be the focus of patient history in the evaluation of large-bowel obstruction (LBO)?
How does the development of colonic lesions vary by location in large-bowel obstruction (LBO)?
What are symptoms of intussusception-related large-bowel obstruction (LBO)?
What are symptoms of acute colonic pseudo-obstruction (ACPO; Ogilvie syndrome)?
What is the focus of the physical exam for large-bowel obstruction (LBO)?
How is an abdominal exam performed in patients with large-bowel obstruction (LBO)?
What are characteristic findings of abdominal distention in large-bowel obstruction (LBO)?
What characteristic findings of palpation of the abdomen in large-bowel obstruction (LBO)?
How is abscess differentiated from large-bowel obstruction (LBO) on physical exam?
How are body masses differentiated from large-bowel obstruction (LBO) on physical exam?
How is an incarcerated hernia etiology of large-bowel obstruction (LBO) determined?
What is the role of a digital rectal exam in the evaluation of large-bowel obstruction (LBO)?
What do the digital rectal exam findings reveal in the evaluation of large-bowel obstruction (LBO)?
What is the role of fecal occult blood testing in the evaluation of large-bowel obstruction (LBO)?
DDX
Which conditions should be included in the differential diagnoses of large-bowel obstruction (LBO)?
What are the differential diagnoses for Large-Bowel Obstruction?
Workup
What is the recommended diagnostic approach to large-bowel obstruction (LBO)?
What is the role of lab studies in the workup of large-bowel obstruction (LBO)?
Which routine lab tests are included in the workup of large-bowel obstruction (LBO)?
What is the role of imaging studies in the workup of large-bowel obstruction (LBO)?
What is the role of plain radiography in the evaluation of large-bowel obstruction (LBO)?
Which findings on radiography are significant in the evaluation of large-bowel obstruction (LBO)?
What is the role of contrast studies in the evaluation of large-bowel obstruction (LBO)?
What is the role of CT scanning in the workup of large-bowel obstruction (LBO)?
What is the role of MRI in the workup of large-bowel obstruction (LBO)?
Treatment
What is included in the initial treatment of large-bowel obstruction (LBO)?
When is a nasogastric tube indicated in the treatment of large-bowel obstruction (LBO)?
What is the role of surgery in the treatment of large-bowel obstruction (LBO)?
When is transfer indicated for the treatment of large-bowel obstruction (LBO)?
What is included in the treatment of ileus in large-bowel obstruction (LBO)?
How is volvulus treated in large-bowel obstruction (LBO)?
What is the recurrence of volvulus in large-bowel obstruction (LBO)?
How is cecal or transverse colon volvulus in large-bowel obstruction (LBO) treated?
What is the role of contrast enema in the treatment of large-bowel obstruction (LBO) in children?
What is the role of contrast enema in the treatment of large-bowel obstruction (LBO) in adults?
What are the indications for surgery in the treatment of large-bowel obstruction (LBO)?
What is the recurrence of intussusception in large-bowel obstruction (LBO)?
What is the role of endoscopic dilation in the treatment of large-bowel obstruction (LBO)?
What are the treatment options for acute left-side malignant large-bowel obstruction (LBO)?
What are the treatment options for right-side malignant large-bowel obstruction (LBO)?
How is large-bowel obstruction (LBO) due to diverticulitis treated?
What are the treatment options for obstructed defecation syndrome (ODS)?
What are possible complications of large-bowel obstruction (LBO)?
How is large-bowel obstruction (LBO) prevented?
What is included in follow-up care after surgery for large-bowel obstruction (LBO)?
Medications
What is the role of medications in the treatment of large-bowel obstruction (LBO)?
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This chest radiograph demonstrates free air under the diaphragm, indicating bowel perforation in a patient with large-bowel obstruction. Radiograph courtesy of Charles J McCabe, MD†.
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Abdominal (kidney-ureter-bladder [KUB]) film of a patient with obstipation. Dilatation of the colon is associated with large-bowel obstruction. Radiograph courtesy of Charles J McCabe, MD†.
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Gastrografin study in a patient with obstipation reveals colonic obstruction at the rectosigmoid level. Radiograph courtesy of Charles J McCabe, MD†.
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Contrast study demonstrates colonic obstruction at the level of the splenic flexure, in this case due to carcinoma. Radiograph courtesy of Charles J McCabe, MD†.
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Abdominal (kidney-ureter-bladder [KUB]) radiograph depicting massive dilatation of the colon due to a cecal volvulus. Radiograph courtesy of Charles J McCabe, MD†.
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Contrast study of patient with cecal volvulus. The column of contrast ends in a "bird's beak" at the level of the volvulus. Radiograph courtesy of Charles J McCabe, MD†.
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Massive dilatation of the colon due to a sigmoid volvulus. Radiograph courtesy of Charles J McCabe, MD†.