Large bowel obstruction

From Ganfyd

Jump to: navigation, search
Large bowel obstruction on abdominal radiograph.

Large bowel obstruction can be a cause of acute abdominal pain and should be distinguished from small bowel obstruction.





Compared to small bowel obstruction the pain is more constant, and often occurs over a distended caecum.

In the post-operative patient obstruction with minimal pain and reuced or absent bowel sounds would imply an ileus rather than mechanical obstruction.

Be wary of strangulation in a patient who is more ill than expected, with a sharper, more constant pain that can be accurately localised. If there is peritonism, fever or a raised white cell count be especially concerned.


  • general abdominal distension
  • tinkling bowel sounds
  • RIF tenderness
    • implies risk of caecal perforation


  • AXR
    • distended large bowel +/- small bowel
    • gas proximal to block, not in rectum
    • large bowel diamter of >8cm implies risk of imminent caecal perforation and requires urgent surgery
  • consider:
    • sigmoidoscopy
    • barium enema


'Drip and suck'

  • fluids
    • 4l Normal saline / 24 hours
  • consider nasogastric tube
  • Bloods
    • cross-match 2 units
  • DVT prophylaxis
  • Antibiotics
  • CXR
  • ECG
  • Analgesia


  • urgent - within 12-24 hours
  • emergency if caecal tenderness or bowel diamter >8cm
  • passing a flatus tube/or performing a barium enema may be sufficient to relieve a sigmoid volvulus (wear an apron)