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.

• Sulfur Granules

  A diverting loop colostomy was performed, and pathology revealed sulfur granules from the extracted IUD that grew Actinomyces. [ncbi.nlm.nih.gov]

• Paraumbilical Hernia

  Computed tomography of the abdomen revealed a paraumbilical hernia containing a segment of transverse colon resulting in partial bowel obstruction. [acgcasereports.gi.org]

• Recurrent Urinary Tract Infection

  Case presentation A 79 year old man presented four years previously to the Urologists with recurrent urinary tract infections and pneumaturia. Cystoscopy revealed a colo-vesical fistula and he was subsequently referred to the colorectal surgeons. [jmedicalcasereports.biomedcentral.com]

• Hyperresonance

  The bowel sounds may be normal early on but usually become quiet, and the abdomen is hyperresonant to percussion. Palpation of the abdomen may reveal tenderness. [emedicine.medscape.com]

• 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]

  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]

  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]

• 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]

  A 32-year-old female patient presented to the emergency department with complaints of diffuse abdominal pain and constipation for 10 days with progressive abdominal distention and vomiting. [ncbi.nlm.nih.gov]

   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]

• 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]

  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]

• Nausea

  Causes include Carcinoma (60%) Diverticulitis (20%) Volvulus Strictures, such as from Crohn disease Fecal impaction Hernia Imperforate anus or meconium ileus in pediatric population Increases in prevalence with age Clinical Findings Abdominal distension Nausea [learningradiology.com]

  Nausea. Vomiting. Abdominal bloating and swelling. Abdominal pain, usually crampy. The pain usually comes in sharp waves and may get better for a while. Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

  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]

  Secondary Objectives: are to evaluate the symptom response (including abdominal pain, distention, bowel frequency and consistency, and nausea and emesis) and complication rate of treatment of malignant large bowel obstruction with endoscopic stent placement [clinicaltrials.gov]

• 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]

  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]

  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]

  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]

  […] pain more constant, vomitting later, much more distension •Presentation: Colicky abdominal pain,constipation/obstipation –Vomiting - late( faeculent) abdominal distension –Fever, sepsis and shock, peritonism •Leftsided tumours: Change in bowel habit, [cram.com]

• Bladder Distention

  Later the patient underwent surgery to remove an enlarged benign prostatic adenoma, which was the underlying cause of the bladder distention. [ncbi.nlm.nih.gov]

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]

  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]

  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]

• 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]

• Ovarian Mass

  C, Photograph of colonic luminal mass, which caused intussusception and consequent large-bowel obstruction, was resected along with ovarian mass and uterus. Colonic mass was metastasis from ovarian carcinoma diagnosed after surgery. [ajronline.org]

• Ischemic Changes

  Perforation may occur at the site of obstruction, or more proximally secondary to ischemic change. Perforation may be implied by the presence of intramural gas. [radiopaedia.org]

and treatment-related complications. [clinicaltrials.gov]

Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). [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]

For malignant etiology, the SEMS procedure was a technical and clinical success in 97.4% of the cases. Complications occurred in 21%, mortality rate 2,6%. [ncbi.nlm.nih.gov]

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]

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]

Epidemiology of blood stream infections in pediatric patients at a tertiary care cancer centre. Indian J Cancer. 2014;51:438-41. Rossolini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis. [jbclinpharm.org]

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]

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]

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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.