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.

Contents

Causes

Clinical

Symptoms

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.

Signs

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

Investigations

  • 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

Management

'Drip and suck'

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

Surgery

  • 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)