Large Bowel Obstruction (LBO)

Last updated 10.08.12

 

Definition

-  Bowel obstruction occurring in the colon (large bowel)

 

Features

-  Mortality 15% w early care

-  36% if ischaemia or perforation

-  Right sided lesions obstruct late

-  Left sided lesions obstruct early

 

Associated S/S

-  Obstipation: constipation & nil flatus

-  Chronic constipation: Diverticulitis, Ca

-  Abdo distention

-  Early = hyperactive bowel sounds

-  Later = hypoactive bowel sounds + tympanic

-  Hyperresonance to percussion

-  Relieved by foetal position: intussusception

-  Nausea & vomiting

-  Crampy abdo pain

-  Abrupt onset: ?volvulus

-  Succession splash

-  Absent bowel sounds

-  Perforation 3-15%

-  Caecum most likely

-  Peritonitis

 

Causes

-  Age dependant

-  Neoplasia most common (60%)

-  Benign strictures: Diverticulitis (20%)

-  Volvulus 5%: sigmoid, caecal

-  Hernias

-  Faecal impaction

-  Colon atresia

-  Endometriosis

 

DDx

-  Olgivie Syndrome

-  Ileus

 

Ix

-  PR Exam

-  Gross or occult blood: strangulation, Ca

-  Masses: obturator hernia

-  U&E

-  Elevated Cr, Urea: dehydration

-  FBE

-  WBC: elevated

-  LDH: strangulation

-  Group & Hold: Sx Mx likely

-  AXR: supine & erect

-  Dilated bowel loops >5cm

-  Air fluid levels

-  Dilated loops

-  Birds beak: volvulus

-  Pneumoperitoneum

-  Erect CXR: pneumoperitoneum (absent in 50% perfs)

-  Gastrograffin

-  CT - Abdo w contrast

 

LBO

 

Mx

-  Fluid resuscitation: NS or Hartmans

-  NGT: bowel decompression

-  Analgesia

-  Antiemetics

-  Abx

-  Sx

-  Laparoscopy, laparatomy

-  As per cause

 

 

 

References

 

eMedicine: emedicine.medscape.com/article/774045-overview