Large-Bowel Obstruction Questions & Answers

Updated: Dec 29, 2017
  • Author: Christy Hopkins, MD, MPH; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Questions & Answers

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 are complete obstruction, partial obstruction and ileus differentiated in 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 sigmoid diverticulitis and a perforated sigmoid due to carcinoma 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 significance of a finding of leukocytosis 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)?

What is included in the treatment of acute colonic pseudo-obstruction (ACPO; Ogilvie syndrome) if no perforation is present?

What is the second-line treatment for acute colonic pseudo-obstruction (ACPO; Ogilvie syndrome) if conservative management fails?

What is the role of surgery in the treatment of acute colonic pseudo-obstruction (ACPO; Ogilvie syndrome)?

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 is the efficacy of colonic stent insertion in the treatment of malignant large-bowel obstruction (LBO)?

What are the treatment options for acute left-side malignant large-bowel obstruction (LBO)?

How do the outcomes of stent insertion compare with surgical decompression in the treatment of large-bowel obstruction (LBO)?

What are the treatment options for right-side malignant large-bowel obstruction (LBO)?

What are the predictive factors for outcomes after self-expandable metal stents (SEMS) for large-bowel obstruction (LBO)?

How does self-expandable metal stents (SEMS) affect histopathologic edema in 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)?

What decisions regarding colostomy or ileostomy for large-bowel obstruction (LBO) must be made prior to discharge?

How is the remaining colon monitored and evaluated after treatment for large-bowel obstruction (LBO)?

Medications

What is the role of medications in the treatment of large-bowel obstruction (LBO)?

Which medications in the drug class Antibiotics are used in the treatment of Large-Bowel Obstruction?