A large bowel obstruction (LBO) can involve a blockage of the whole or part of the colonic lumen. Firstly, if the obstruction is complete, the patient presents with acute and profound symptomatology; in a partial large bowel obstruction the symptoms are milder and it is not a threatening condition.

A patient affected by partial large bowel obstruction presents with a medical history of constipation, but and reports the passing of a reduced amount of gas as well as stool. In a complete large bowel obstruction, the main symptoms are usually characteristic, with the individuals complaining of abdominal pain and distention, complete inability to pass fecal matter and gas, and vomiting [1] [2] [3]. Patients who report with severe abdominal pain, rigidity, guarding, fever and signs of shock, with a medical history of constipation and distention should be treated immediately, as a large bowel obstruction can likely evolve into a perforation and subsequent peritonitis.

Other findings that may also be noticed are usually not caused by LBO itself, but by the underlying pathology. Intermittent left-lower-quadrant pain in the abdomen over a long period of time and generally recurring constipation may be caused by diverticulitis. This sign together with colorectal cancer and volvulus forms the three primary causes of LBO [4]. Weight loss may be reported by individuals who are affected by colorectal cancer.

• Shivering

  Early signs of sepsis include: fever, shivering, or feeling cold fast heart rate fast breathing and shortness of breath sweaty or clammy skin changes in mental state, such as feeling sleepy, confused, or losing interest If medical attention is not accessed [medicalnewstoday.com]

  However, patients may have many other signs and symptoms that can occur with sepsis, such as elevated heart rate (tachycardia), fever, low body temperature (hypothermia), a reduced carbon dioxide (PaCO2) level in the blood, chills, dizziness, fatigue, shivering [medicinenet.com]

• Pneumonia

  Immunize patients to prevent S pneumoniae pneumonia and N meningitidis meningitis. [atsu.edu]

  The resistance to cefoperazone–sulbactum in Klebsiella pneumoniae and E. coli was 65% and 48% respectively. [jbclinpharm.org]

  Chest radiography often provides useful information about the cause of a patient’s respiratory failure, for example pulmonary edema or pneumonia. [accessemergencymedicine.mhmedical.com]

  They may follow an injury, surgery, or another localized infection, such as pneumonia. [healthline.com]

  There may be infections such as pneumonia, or intestinal bleeding. The obstructed bowel may not be getting enough oxygen, or the bowel may become perforated, that is, a hole may develop in the intestinal wall. [virtualhospice.ca]

• Constipation

  A patient affected by partial large bowel obstruction presents with a medical history of constipation, but and reports the passing of a reduced amount of gas as well as stool. [symptoma.com]

  He has a history of diverticulosis and chronic constipation. He last had a bowel movement 1 week ago and has not had any flatus in the past day. He reports 2 episodes of vomiting at home. [step2.medbullets.com]

  Absolute constipation for 24 hours. Obstruction? Patient Data Age: 70 years Gender: Male The large bowel is gas filled and distended down to the level of the distal descending colon-sigmoid. Small bowel collapsed. No free gas. [radiopaedia.org]

  A 76-year-old man presented to the emergency department with diffuse abdominal pain and constipation. In the few months before this admission the patient had complained of strenuous micturition. [ncbi.nlm.nih.gov]

• Vomiting

  He reports 2 episodes of vomiting at home. On physical exam, his abdomen is distended and there is diffuse tenderness to palpation. A CT of his abdomen and pelvis shows dilated loops of bowel and a suspicious mass at the transition point. [step2.medbullets.com]

   Abdominal pain  Distention  Constipation  Nausea  Vomiting 8.  Proximal obstruction: early bilious vomiting.  Distal obstruction: constipation, distension, vomiting feculent material (bacterial overgrowth of contents).  Distal obstruction: [slideshare.net]

  [citation needed] Special bags are often supplied on boats for sick passengers to vomit into. Most people try to contain their vomit by vomiting into a sink, toilet, or trash can, as vomit is difficult and unpleasant to clean. [en.wikipedia.org]

  Toxic megacolon Acute colonic pseudo-obstruction Step 1: Pathway Entry Symptoms: Abdominal pain (normally colicky), bloating, change in bowel habit, tenesmus, rectal bleeding, recent weight loss, nausea and vomiting Signs: Abdominal distension, tympanic [aci.health.nsw.gov.au]

• Abdominal Pain

  Abnormalities of the left hemidiaphragmatic contour on plain radiographs of the chest should suggest the diagnosis in patients who have abdominal pain, colonic dilatation, and a history of abdominal injury. [ncbi.nlm.nih.gov]

  View larger version (315K) Fig. 2A —49-year-old woman with abdominal pain. [ajronline.org]

  In a complete large bowel obstruction, the main symptoms are usually characteristic, with the individuals complaining of abdominal pain and distention, complete inability to pass fecal matter and gas, and vomiting. [symptoma.com]

  […] location of abdominal pain can provide information about what may be causing the pain. [en.wikipedia.org]

• Nausea

  The most common symptoms include not being able to pass gas or have a bowel movement, nausea, vomiting, bloating, abdominal swelling and pain. There are different treatments depending on the type of bowel obstruction you have. [my.clevelandclinic.org]

  Nausea, swollen abdomen, constipation, and a change in your stool are all bowel obstruction symptoms. Get the facts about this uncommon but serious condition. Medically Reviewed by Pat F. [everydayhealth.com]

  The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. [ncbi.nlm.nih.gov]

  This is the characteristic presentation of a sigmoid volvulus 19.  20 year old woman presented to the ED with 12 hours of abdominal pain, nausea. and vomiting low grade fever.  No past surgical history  PMH: Polycystic ovarian disease 20. [slideshare.net]

• Abdominal Distension

  Snap Shot A 65 yo presents with abdominal distension and colicky pain. Introduction Adhesions are the most common cause of all bowel obstructions. [medbullets.com]

  The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. [ncbi.nlm.nih.gov]

  distension Nausea and vomiting Crampy abdominal pain Constipation, diarrhea, change in bowel habits Imaging Findings Air in dilated colon, usually to the point of obstruction Dilated cecum Small bowel is not dilated unless ileo-cecal valve becomes incompetent [learningradiology.com]

  Toxic megacolon Acute colonic pseudo-obstruction Step 1: Pathway Entry Symptoms: Abdominal pain (normally colicky), bloating, change in bowel habit, tenesmus, rectal bleeding, recent weight loss, nausea and vomiting Signs: Abdominal distension, tympanic [aci.health.nsw.gov.au]

  A 64-year-old man presented with abdominal distension, pain, and vomiting for 5 days. Computed tomography scan of the abdomen showed dilated small intestine and colon, air in the biliary tree, and a calcified mass in the sigmoid colon. [amjmed.org]

• Hematuria

  Urinary tract infection was diagnosed through typical signs and symptoms including fever, urgency, frequency, dysuria, pyuria, hematuria, positive Gram stain, pus, and suggestive imaging. [ccforum.biomedcentral.com]

The diagnosis of large bowel obstruction is made primarily via the use of imaging modalities, as well as laboratory tests that do not exactly serve the diagnostic purposes but help to comprehensively evaluate the patient's status. The elimination of ileus as a possible alternative diagnosis is also carried out via laboratory tests.

Blood tests involve:

• Complete blood count. A significantly raised white blood count indicates peritonitis, as opposed to uncomplicated large bowel obstruction.
• Biochemical profile, including electrolytes, lactate dehydrogenase (LDH), glucose, alkaline phosphatase (ALP), urea, creatinine, cholesterol, triglycerides, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) etc. Prothrombin type (PT-INR) and serum lactate should also be measured, with the latter helping in the detection of potential perforation. Liver function tests are also recommended.
• Stool guaiac test
• Crossmatch

Imaging modalities include the following:

• Radiography: It constitutes the very initial imaging method used, with a specificity and sensitivity of approximately 70 and 80% [5]. Abdominal radiographs are obtained in a supine and erect position and can illustrate air-fluid levels and colonic diameter; free air indicative of pneumoperitoneum due to perforation is also depicted.
• Computerized Tomography scan (CT scan): It can provide the physician more information than a plain radiograph; this accounts for the rising replacement of X-rays by a CT scan in the present day [6]. The administration of contrast media can differentiate between partial and complete obstruction, small and large bowel obstruction and ileus [6].
• Multiple detector computed tomography (MDCT). Its sensitivity is 96%, while the specificity is approximately 93% [7] [8]. The cause of LBO, potential complications, and its ability to differentiate between pseudo-obstruction, volvulus of the colon and other pathologies render it an extremely useful means of evaluating a possible large bowel obstruction.

• Bowel Distention

  During the freeze cycle of endoscopic spray cryotherapy, high-flow nitrogen was injected onto the tumor, which caused bowel distention. [acgcasereports.gi.org]

  Obstipation or constipation Abdominal distention High-pitched, tinkling bowel sounds (early) Absent bowel sounds (late) Diffuse, continuous abdominal pain Vomiting Obstipation or constipation Marked abdominal distention Tympany on percussion Absent bowel [amboss.com]

  TABLE 1: Causes of Large-Bowel Obstruction by Location When a patient presents acutely with abdominal pain, abdominal distention, nausea, and vomiting, bowel obstruction is a leading consideration. [ajronline.org]

  Pathophysiologic effects of bowel distention on intestinal blood flow. Am J Surg. 1969;117(2):228–34. PubMed Google Scholar 9. Stillwell GK. The law of Laplace. Some clinical applications. Mayo Clinic Proc. 1973;48(12):863–9. Google Scholar 10. [link.springer.com]

• X-Ray Abnormal

  Home » Tutorials » Abdominal X-ray Tutorials » Abdominal X-ray - Abnormal bowel gas pattern » Introduction » 1 2 3 4 5 6 » Conclusion Key points Dilatation of the caecum >9cm is abnormal Dilatation of any other part of the colon >6cm is abnormal Abdominal [radiologymasterclass.co.uk]

• Polyps

  A flexible sigmoidoscopy was performed for further evaluation of the lesion and showed a sigmoid polyp and diverticulosis, in addition to the mass. Answer and discussion on next page. [consultant360.com]

  Colorectal cancer is one of the most common cancers in western countries, typically arising within an adenomatous polyp. [merckmanuals.com]

   Neoplasms  Lipoma  Polyps  Hematoma  Lymphoma  Carcinoid  Secondary Tumors  TB Strictures 4.  Postoperative adhesions.  Congenital adhesions  Hernia  Volvulus 5. 1. Carcinoma: The commonest cause that present with obstruction. 2. [slideshare.net]

  Figure 4: Hypothetical timeline and interactions of events in the formation of nasal polyps. (Left) The damaged epithelium responds to injury from pathogens, proteases, and irritants. Abbreviations: B... See More [annualreviews.org]

  CT colonography (CTC) has been reliably proven to have comparable sensitivity and specificity to optical colonoscopy in the detection of colorectal polyps and cancer [8]. [ajronline.org]

Twenty-five studies of the diagnosis and treatment of obstruction and 34 studies of the use of stents were assessed. [ncbi.nlm.nih.gov]

Stent insertion does not seem to have a deleterious effect on prognosis. [ncbi.nlm.nih.gov]

Prognosis of Large Bowel Obstruction The prognosis for someone with a large bowel obstruction depends on many factors, including the timing of treatment, the patient’s age, the cause of the obstruction, and the presence of other illnesses, particularly [newhealthadvisor.com]

Prognosis[edit] The prognosis for non-ischemic cases of SBO is good with mortality rates of 3–5%, while prognosis for SBO with ischemia is fair with mortality rates as high as 30%.[26] Cases of SBO related to cancer are more complicated and require additional [en.wikipedia.org]

The etiology of LBO is usually divided into neoplastic diseases and nonneoplastic diseases. However, the most common cause is the neoplastic etiology. [jhu.pure.elsevier.com]

LBO etiology comprises two main categories: neoplastic and nonneoplastic disease. [ncbi.nlm.nih.gov]

Primary carcinoma of the colon, volvulus, and diverticulitis were the etiological factors in 84% of the patients. The combined hospital mortality of 37% was distributed as follows: county, 42%; VA, 40%; and community, 30%. [jamanetwork.com]

Details about this forecast and other discussions of sepsis epidemiology can be found in the EpiCast Report: Sepsis and Septic Shock – Epidemiology Forecast to 2026 and the EpiCast Model: Sepsis and Septic Shock – Epidemiology Forecast to 2026. [hospitalmanagement.net]

Introduction Overview large bowel obstruction, or LBO, is a surgical emergency and requires intervention obstruction may be partial or complete complete obstructions require immediate surgical intervention Epidemiology demographics elderly patients etiology [step2.medbullets.com]

“Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends”. Inflammatory Bowel Disease 2011; 17 (1), 423–439. Castro M., Papadatou B., Baldassare M., Balli F. et al. [ragazzicoraggiosi.it]

Organ dysfunctions during severe sepsis and septic-like syndromes: epidemiology, classification, and mechanism. Cavaillon J-M, Adrie C, eds. [medscape.com]

Etiology Pathophysiology Clinical features Diagnostics Treatment Differential diagnoses Complications [amboss.com]

Focus is on predisposing factors, microbiology, pathophysiology, and the 4 components of therapy -- antibiotics, volume replacement, steroids, and surgical drainage. [ncbi.nlm.nih.gov]

The lower 6 thoracic segments supply the sympathetic tone to the right colon, whereas lumbar segments 1-3 supply the left colon. [5, 6] Pathophysiology The exact pathophysiology of intestinal pseudo-obstruction remains to be elucidated. [7] Current theories [emedicine.medscape.com]

In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 10, 2015. Glancy DG. Intestinal obstruction. [mayoclinic.org]

The objective of the present study is to investigate the differences in pathophysiology and the clinical course of bacteremia caused by different bacterial species. [ccforum.biomedcentral.com]

Surgical management is the treatment of choice to prevent the disastrous complications of large-bowel obstruction. We describe the case of a 92-year-old man who presented with symptoms and signs of large-bowel obstruction. [ncbi.nlm.nih.gov]

How to Prevent Large Bowel Obstruction To prevent a large bowel obstruction, you should live a healthy lifestyle. [newhealthadvisor.com]

1. Ramanathan S, Ojil V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes. J Clin Imaging Sci. 2017; 7: 15.
2. Zielinski MD, Eiken PW, Bannon MP, et al. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg. 2010;34:910–19.
3. Pujahari AK. Decision Making in Bowel Obstruction: A Review. J Clin Diagn Res. 2016 Nov;10(11).
4. Yeo HL, Lee SW. Colorectal emergencies: Review and controversies in the management of large bowel obstruction. J Gastrointest Surg. 2013;17:2007–12.
5. Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 3rd ed. Philadelphia, PA: Saunders, Elsevier; 2008.
6. Jaffe T, Thompson WM. Large-bowel obstruction in the adult: classic radiographic and CT findings, etiology, and mimics. Radiology. 2015 Jun;275(3):651-63.
7. Frager D, Rovno HD, Baer JW, Bashist B, Friedman M. Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging. 1998;23:141–6.
8. Godfrey EM, Addley HC, Shaw AS. The use of computed tomography in the detection and characterisation of large bowel obstruction. N Z Med J. 2009;122:57–73.