Large bowel obstruction is a surgical emergency that must be quickly differentiated from pseudo-obstruction to ensure that timely and correct treatment is provided.Consider malignancy in all patients who present with large bowel obstruction.Suspect bowel perforation where there is persistent tachyc Large Bowel Obstruction. Mechanical obstruction of the colon from: -Malignancy: Colorectal cancer; Extracolonic tumors (peritoneal carcinomatosis, local invasion, lymphadenopathy) -Colonic Diverticulitis (causing strictures) -Fecal impaction, -Volvulus (Cecal volvulus, Sigmoid volvulus) -Adhesions. -Ischemic stricture. -Intussusception The underlying etiology of large bowel obstructions is age-dependent, but in adulthood, the most common cause is colonic cancer (50-60%), typically in the sigmoid 1-4. The second most common cause in adults is acute diverticulitis (involving the sigmoid colon) Bowel obstruction must be differentiated from other diseases that cause abdominal pain, nausea and vomiting, and constipation, such as irritable bowel syndrome, volvulus and acute diverticulitis. The following tables discusses differential diagnoses based on abdominal pain with nausea and vomiting
ferentiated into small bowel and large bowel obstruction. Fluid loss from emesis, bowel edema, and Table 2. Differential Diagnosis of Abdominal Pain,. A large bowel obstruction is a medical emergency. It occurs when a tumor, scar tissue or something else blocks the large intestine. Gas and stool build up, and the intestine may rupture. Some bowel obstructions improve with minimal treatment in the hospital The hallmarks of intestinal obstruction include colicky abdominal pain, nausea, vomiting, abdominal distension, and cessation of flatus and bowel movements. The differential diagnosis should be.. Bowel Obstruction. The most common cause of small bowel obstruction is adhesions from previous abdominal surgeries, followed by hernias and malignancy. Small bowel obstruction commonly presents with nausea, bilious vomiting, abdominal pain, and distension. Obstipation can occur which is the inability to pass gas or stool (13)
The radiographic appearance of colonic obstruction depends on the competency of the ileocecal valve. If the ileocecal valve is competent, obstruction causes a large dilated colon, with a markedly distended thin-walled cecum and little small-bowel gas ().If the ileocecal valve is incompetent, however, there is distention of gas-filled loops of both the colon and small bowel (), often with cecal. Kahi CJ, Rex DK. Bowel obstruction and pseudo-obstruction. Gastroenterol Clin North Am. 2003 Dec. 32(4):1229-47.. Pujahari AK. Decision making in bowel obstruction: a review This book presents a practical guide to the diagnosis and management of obstruction, both mechanical and organic, of the large and small bowel. Obstruction is a common problem for surgeons, and this text emphasizes differential diagnosis and the use of all radiologic modalities
Large-bowel obstruction. The differential diagnosis includes bowel ischemia, bowel perforation, necrotizing enterocolitis (given the presence of pneumatosis), intra-abdominal abscess, adynamic ileus, or Ogilvie syndrome Large bowel diameter ≥5-6cm is associated with obstruction. CT. Can usually identify the cause of obstruction, except in cases of pseudo-obstruction. Sensitivity for diagnosing large bowel obstruction as high as 90% (not as high as for small bowel obstruction) Can also diagnose intestinal ischemia. Colonoscopy A large bowel obstruction (herein, LBO) occurs when there is a blockage in the large bowel, either partial or complete, leading to an interruption of the normal flow of intra-luminal gastric contents. It is an important condition to identify, as it requires urgent medical or surgical treatment, particularly in the case of a complete obstruction Differential Diagnosis. A A Font Size Share Print More Information. Disease/Condition. Ileus. Large bowel obstruction. Differntiating Signs/Symptoms. Very distended abdomen; constipation progressing to absolute constipation. X-ray and CT may show dilated small or large bowel, which may be massively dilated. Appendicitis
The most serious complication is bowel ischemia. Differential diagnosis. large bowel obstruction from other causes; cecal volvulus: to differentiate between sigmoid volvulus and cecal volvulus please refer to sigmoid volvulus versus cecal volvulus article; colonic pseudo-obstruction . The CT exam has become the most important imaging modality for the diagnosis of LBO, following abdominal ultrasound and plain radiography. The recent multi-detector CT (MD-CT) is able to clarify the etiology of LBO and to help in deciding how to treat LBO
. Tests and procedures used to diagnose intestinal obstruction include: Physical exam. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there's a lump in your abdomen Large-bowel obstruction is an abdominal emergency with high morbidity and mortality rates if left untreated. Although abdominal radiography is usually the initial imaging study performed in patients suspected of having large-bowel obstruction, it may not be sufficient to distinguish obstruction from other causes of colonic dilatation
- Causes of bowel obstruction - AAST grading criteria for small bowel obstruction - Drugs causing constipation - Differential diagnosis of nausea and vomiting - Mechanical versus functional intestinal obstruction - Classification of internal hernias; RELATED TOPICS. Acute appendicitis in adults: Clinical manifestations and differential diagnosis The symptoms of bowel obstruction are typically less severe in partial bowel obstruction than in total bowel obstruction. A diagnosis of bowel obstruction should be confirmed on imaging (e.g., CT abdomen and pelvis) The most common cause of large bowel obstruction is an underlying colorectal malignancy. Approximately 40% of colorectal cancers present as emergencies and large bowel obstruction is the most common presentation. Benign causes of large bowel obstruction are strictures secondary to diverticular disease or inflammatory bowel diseases, as well as.
The following conditions should be considered in the differential diagnosis of small-bowel obstruction (SBO): Esophageal rupture or tear. Gastrointestinal foreign body. Gastroenteritis. Inflammatory bowel disease. Mesenteric ischemia. Large-bowel obstruction Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. [ncbi.nlm.nih.gov] Obstruction , Large Bowel at eMedicine [en.wikipedia.org
Small bowel obstructions are most often due to adhesions and hernias while large bowel obstructions are most often due to tumors and volvulus. The diagnosis may be made on plain X-rays; however, CT scan is more accurate. Ultrasound or MRI may help in the diagnosis of children or pregnant women Large bowel obstruction has many causes all of which should be considered and addressed during history taking, examination and forming a differential diagnosis. The most common causes of large bowel obstruction are neoplastic, volvulus and diverticular disease  Given the large differential diagnosis for @NAME@, the decision making in this case is of high complexity. After evaluating all of the data points in this case, the presentation of @NAME@ is NOT consistent with an infected stone, nephric abscess, sepsis, or renal failure In an adult, large bowel obstruction is cancer until proven otherwise. Key radiological features are dilated bowel loops that are peripheral, contain haustra and contain faeces. Causes. Tumor (usually sigmoid carcinoma) Volvulus (sigmoid, cecal) Fecal impaction; Benign stricture (e.g. post-operative, inflammatory bowel disease) Abscess. Large bowel obstruction (LBO) is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. MDCT has become the standard of care to identify the site, severity, and etiology of obstruction. The goal of this review is fourfold. The first objective is to give clues to differentiate LBO from colonic pseudo-obstruction
Small and large bowel obstructions are responsible for approximately 15% of hospital admissions for acute abdominal pain in the USA and ~ 20% of cases needing acute surgical care. Starting from the analysis of a common clinical problem, we want to guide primary care physicians in the initial management of a patient presenting with acute abdominal pain associated with intestinal obstruction CONTENTS Basics Clinical presentation Differential diagnosis Evaluation Causes Approach & management Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) definition Acute colonic pseudo-obstruction refers to a paralytic ileus of the colon which causes severe colonic dilation. In some cases the small bowel may also be involved. This is not due to anatomic [
The Differential Diagnosis of Intestinal Obstruction Solomon S. Schwartz, M.D. THE DIFFERENTIAL DIAGNOSIS of intestinal obstruction is made difficult by a welter of terms and by failure to understand the significance of fluid and gas.28 TERMINOLOGY It seems hopeless to urge a more precise definition of terms, yet this is needed Large bowel obstruction complicating a posttraumatic diaphragmatic hernia. which was closed with a nonabsorbable suture. Posttraumatic diaphragmatic hernias should be part of the differential diagnosis for patients with bowel obstruction, especially if there is a history of trauma. Radiography is useful in facilitating a quick diagnosis Alerts and Notices Synopsis A large bowel obstruction refers to an obstruction of the large intestine resulting in proximal bowel dilatation and inability of stool or gas to pass distal to the level of obstruction. Large bowel tumors are most commonly caused by compressive malignancies. Adhesions, volvulus, strictures, or incarcerated hernias can also lead to obstruction of the large intestine Inflammatory bowel disease Obstruction (small or large bowel)-Colonic strictures; Postinflammatory, radiation, ischemic, or surgical stenosis-Obstructive colonic mass lesions / Extraintestinal mass-Colorectal cancer-Hernia Pelvic floor dysfunction Rectal prolapse or rectocele Neurologic Autonomic neuropathy, Multiple sclerosis Spinal cord. The differential diagnosis can then be limited to a subset of conditions that cause pain in that particular quadrant of the abdomen . Several other pivotal points can help narrow the differential diagnosis including (1) the time course of the pain, (2) peritoneal findings on exam, (3) unexplained hypotension, and (4) abdominal distention
. In Westernized nations, approximately 85% of patients with large-bowel obstruction present with colorectal carcinomas, 1 and in fact malignant obstruction is the initial presentation of colon cancer in as many as 20% of colon cancer diagnoses. 2 The remaining 10% to 15% of patients obstruct secondary to volvulus, diverticular stricture. Large bowel obstruction is an interruption in the normal flow of intestinal contents through the colon and rectum. This obstruction may be mechanical (due to the actual physical occlusion of the lumen) or functional (due to a loss of normal peristalsis, also known as pseudo-obstruction) Answer. Conditions that should be considered when evaluating a patient with large-bowel obstruction (LBO) include constipation, cecal or sigmoid volvulus, intussusception, intestinal perforation.
Differential diagnosis. The two most common differentials for paralytic ileus are pseudo-obstruction (AKA Ogilvie syndrome) and mechanical bowel obstruction. In contrast to paralytic ileus, pseudo-obstruction effects only the large bowel and does not involve the small bowel, as can be seen on imaging (Abdominal X-Ray). Management 1. To confirm diagnosis: Plain abdominal x-ray (erect and supine) Erect x-ray shows - multiple air fluid levels with absence of rectal shadows. Framanda lines are seen if it is due to volvulus. Supine x-ray shows - dilated loops of bowel, central dilatation for small bowelobstruction and peripheral dilatation for large bowel obstruction Newborn Differential Diagnoses: Given the large differential for bowel obstruction in children it is helpful to break it up into conditions that present in the newborn period, and other conditions that present later in infancy and childhood. Let's relate what we've learned to two clinical cases and consider conditions that present in th Large bowel involvement Functional immaturity of the colon Hirschsprung disease Colonic atresia Anal atresia and anorectal malformations I ntestinal obstructions are the most common surgical emergencies in the neonatal period. Early and accurate diagnosis of intestinal obstruction is paramount for proper patient management Cases of reservoirs causing erosion into the bladder, small bowel obstructions, vascular compression, and inguinal herniation have been described. We highlight the importance of keeping a broad differential diagnosis when assessing patients with bowel obstructions
Differential diagnosis. A provisional diagnosis of large bowel obstruction secondary to an incarcerated Morgagni hernia was made. However, other causes of large bowel obstruction in an elderly man was also considered such as a neoplastic cause. With CT and X-ray imaging confirming herniation of intra-abdominal contents into the chest, other. Differential diagnosis. Common conditions which may be mistaken for IBS include: Inflammatory bowel disease as in Crohn's disease (ulcerative colitis) Symptoms which suggest obstruction of the intestine, called intestinal pseudo-obstruction, as in diabetes or scleroderma; Abuse of medications such as laxatives or bowel binders; Lactose intoleranc . Early diagnosis and appropriate treatment usually results in positive outcomes. Delay in carrying out surgery may result in the loss of large amounts of bowel. Not all infants with bowel obstruction require transfer by PIPER neonatal
The differential diagnosis can be made with the following conditions: large bowel obstruction of other etiologies, caecal volvulus and colonic pseudo-obstruction. Sigmoid Volvulus Pictures Sigmoid Volvulus Picture 1 : In the left side image, you can see the unattached loop of bowel getting twisted resulting in the obstruction of bowel lumen. Large bowel obstruction is a common symptom of colorectal cancer, with an incidence range of 15% to 29%. [ 2] Obstruction is also the most common indication for emergency surgery for colorectal cancer, comprising 77% of emergencies. [ 3] Similarly, colonic malignancy is the most common cause of large bowel obstruction in adults Differential Diagnosis. The main differential diagnoses to consider are the alternative causes for bowel obstruction, as well as severe constipation, pseudo-obstruction, and severe sigmoid diverticular disease. Investigations. All patients presenting with clinical features of bowel obstruction should be investigated accordingly Consider intestinal obstruction in the differential diagnosis of patients presenting with abdominal pain, distention, emesis, and obstipation. System(s) affected: gastrointestinal (GI) Neoplastic (most common cause of large bowel obstruction in adults) Miscellaneous (e.g., endometriosis, pseudomyxoma peritonei). Small bowel obstruction; Large bowel obstruction; Localized ileus; Generalized ileus; KEY FEATURES TO LOOK FOR WHEN CHARACTERIZING THE FINDING. When seeing a bowel dilation, there are a few important radiological features one should look at to try and characterize this finding. These features can help navigate the differential diagnosis above
Perforated hollow viscus should be considered in the differential diagnosis for any patient presenting with an acute abdomen. Often, patients describe initially localized, visceral pain that becomes diffuse, dramatic, and severe, and progresses to peritonitis. Large-bowel obstruction, small-bowel obstruction, stercoral ulcer: Trauma: Blunt. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. [ncbi.nlm.nih.gov] Recurrent Small Bowel Obstruction The differential diagnoses for low intestinal obstruction include ileal and colonic atresia, anorectal malformation, meconium ileus, colonic dysmotility syndromes, and Hirschsprung's disease. Congenital abdominopelvic cysts or masses can cause both high and low (usually partial) obstruction
the differential diagnosis of a patient evaluated for large bowel movements with a bowel regimen of Golytely, daily mineral oil enemas, and miralax. Conventional radiograph with bowel obstruction, the vast majority of patients diagnose abdominal while in large bowel obstruction the pain is below the umbilicus •The more proximal the bowel obstruction, the more frequent the vomiting Make a differential diagnosis of the most likely underlying cause of the peritonitis/ abscess. 2. Administer normal saline or Ringer's lactate, depending o As with all of acute surgery, in evaluating the patient with acute large bowel obstruction, the surgeon must first evaluate the patient's severity of illness, establish a differential diagnosis and then decide upon the priorities in safely treating the patient. In contrast to continental Europe and the UK, where magnetic resonance imaging is. The differential diagnosis can then be limited to a subset of conditions that cause pain in that particular quadrant of the abdomen . + + Figure 3-1. The differential diagnosis of abdominal pain by location. Small or large bowel obstruction. Chronic mesenteric ischemia. IBD. IBS. Hepatitis. PUD Abdominal radiographs demonstrate a distal bowel obstruction (multiple dilated bowel loops with air-fluid levels). A single markedly dilated loop with a large fluid level is often more indicative of atresia ( Fig. 6A ). 13,15 However, due to the many variations of atresia, radiographic findings are diverse, and these findings are not absolute
Although large bowel obstructing mass often due to colon cancer, pancreatic adenocarcinoma can rarely have the same presentation, and should be considered in the differential diagnosis of large bowel obstruction. Patients with a known diagnosis of pancreatic cancer presenting with large bowel obstruction with hemodynamic stability are better. Background. Large-bowel obstruction (LBO) is an emergency condition that requires early identification and intervention. The etiology of this condition is age-dependent, and it can result either from mechanical interruption of the flow of intestinal contents (see the following image) or from dilation of the colon in the absence of an anatomic lesion (pseudo-obstruction) Small bowel adenocarcinoma - most important differential diagnosis. Metastatic adenocarcinoma - classically on the serosal aspect. Signet ring cell carcinoma. Sign out Small Bowel, Resection: - Small bowel wall with focal ischemia and fibrous adhesions, surgical margins appear viable Primary colonic bezoars are extremely rare. Review of literature revealed only two reports of primary colonic bezoar causing large bowel obstruction. 10,11 Conventional abdominal radiographs are usually enough to detect bowel obstruction; however, its causation due to bezoar is difficult to diagnose on plain radiographs alone
Barium enema is not sensitive in the diagnosis of small bowel obstruction except in distal small bowel obstruction where large bowel obstruction masquerades as small bowel obstruction. Barium (or gastrografin, a water soluble hyperosmolar contrast) enema is utilized more frequently in large bowel obstruction to differentiate pseudo-obstruction. Diagnosis: High-grade small bowel obstruction due to internal hernia with small bowel pneumatosis and small volume pneumoperitoneum. In cases with bowel obstruction, the radiologist should aim to identify the cause of the obstruction as early surgical reversal may be curative for the patient
Figure 4: Large bowel obstruction secondary to diverticular stricture. Plain radiographs of the abdomen, supine and erect views (a and b) in a 45-year-old man presenting to the emergency department with severe abdominal pain and lack of bowel movements demonstrate markedly dilated loops of large bowel compatible with large bowel obstruction Specific Diagnoses • In patients above fifty years of age the top four reasons for acute abdominal pain are: Biliary Tract Disease (21%,) NSAP (16%), Appendicitis(15%), and Bowel Obstruction (12%). • In patients under fifty years of age the top three reasons for acute abdominal pain are: NSAP (40%,) Appendicitis (32%,) and Other (13%.) 25 severe constipation rather than frank obstruction. The diagnosis of acute colonic pseudo-obstruction typically results from resolution of a differential diagnosis that includes mechanical obstruction of the large bowel (for example malignant and benign strictures and volvulus). However, the condition may occasionally also accompan
Obstruction forms in either Small Bowel (much more common) or Large Bowel. Bowel dilates proximal to obstruction. Flatus and Bowel Movement s cease. Dehydration results from Vomiting, minimal absorption, and bowel edema. Metabolic Alkalosis and Hypokalemia. Vomiting: Potassium, chloride and Hydrogen Ion loss Small-Bowel Obstruction Francis K. Lee George Chapman is a 42-year-old man who presents to the emergency department complaining of 3 days of crampy abdominal pain, nausea, and vomiting. Prior to the onset, he has had occasional abdominal colic that was relieved by intermittent bowel movement. However, for the past 3 days he has not ha Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Colonic Ileus and Ogilvie Syndrom In large bowel obstruction the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction. Diagnosis. The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning and/or ultrasound Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion.It can occur at any level distal to the duodenum of the small intestine and is a medical emergency.The condition is often treated conservatively over a period of 2-5 days with the patient's progress regularly monitored by an.