Large bowel obstruction
- Sigmoid volvulus
- Vomiting with relief
- Colicky abdominal pain with distension
- absolute constipation (absence of flatus) is diagnostic of
- 'Tinkling', high-pitched bowel sounds
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
- 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
- barium enema
'Drip and suck'
- 4l Normal saline / 24 hours
- consider nasogastric tube
- cross-match 2 units
- DVT prophylaxis
- 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)