Large bowel obstruction

32 Large bowel obstruction



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Fig. 32.1A This patient has large bowel obstruction, with dilated colon all the way to the mid descending colon. Note the incidental gallstones.



Background


Please read the section on small bowel obstruction as many of the points also apply here (Chapter 30).


Plain films are first line for diagnosis of large bowel obstruction although more complex investigations may be necessary to determine its cause.


Again, obstruction may be mechanical or functional. The commonest causes of mechanical obstruction are malignancy and diverticular disease. Volvulus is a less common, special form of obstruction which is discussed separately (Chapters 33 and 34). Pseudo-obstruction can affect the colon as well as small bowel and no plain film feature will differentiate the two conditions.


As in small bowel obstruction, look for evidence of perforation and remember to request an erect CXR.



Clinical features



Symptoms


Symptoms include colicky low abdominal pain, vomiting, absolute constipation and abdominal distension. Acute onset suggests a volvulus.


There may be symptoms preceding the obstruction that suggest an underlying tumour – weight loss, haematochezia, etc.



Signs



• Distended tympanic abdomen. Look for an abdominal mass.

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Large bowel obstruction

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