LARGE BOWEL OBSTRUCTION

DEFINATION LARGE BOWEL OBSTRUCTION (LBO) Large-bowel obstruction is an emergency

condition that requires early identification and intervention. The etiology of this condition is age dependent, and it can result from either mechanical interruption of the flow of intestinal contents or by the dilation of the colon in the absence of an anatomic lesion (pseudo-obstruction)

CAUSES/RISK FACTORS

Common causes: cancerOther causes: volvulus,

diverticular disease, inflammatory disorders. E.g: crohn’s disease and fecal impaction.

SIGN AND SYMPTOM

1.Vomiting 2.bloating 3.constipation and lack of gas(if intestine is

completely blocked) 4.diarrhea(if the intestine is partly blocked) 5.cramping and belly pain that comes and

goes.The pain can occur around or below the belly button.

SMALL BOWEL OBSTRUCTION

LARGE BOWEL OBSTRUCTION

The colon proximal to the cause of mechanical obstruction (e.g., malignancy, colonic volvulus, benign ) dilates and, with

increased colonic pressure

mesenteric blood flow is reduced producing mucosal oedema with transudation of fluid and electrolytes into the colonic

lumen

This can produce dehydration and electrolyte imbalances. With progression, the arterial blood supply becomes disturbed

with mucosal ulceration

This results in ischaemia, necrosis, and perforation.

INVESTIGATIONS

1 ) Flat and upright Abdominal x-ray  show distended bowel

2) CT Scan

    to assess the cause of the obstruction

3) Gastrografin

    to provide contrast than barium when bowel obstruction is suspected

4 ) Barium enema to confirm diagnosis of large bowel obstruction

5 ) Blood investigation

evaluate presence of infection & fluid and electrolyte imbalanceWBC - high due to inflammatory response

BLOOD INVESTIGATION

1 ) serum osmolality & electrolyte levels

2 ) in hypovolemia

3 ) arterial blood gases (ABG)

TREATMENT

1. Insertion of nasogastric tube through your nose and down into your stomach. The tube removes fluids and gas and helps relieve pain and pressure. You will not be given anything to eat or drink.

SURGICAL TREATMENT

Exploration – make incision (cut) and inspect what is the cause and remove the infarcted part or gangreous tissue.

Laparotomy- surgical opening of the abdomen.

SURGICAL TREATMENT (CON’T)

If obstruction was caused by adhesion – removed or lysed.

If tumours are found- resected.

If foreign bodies are found- removed.

COMPLICATION

1.Hypovolemia shock: -Renal insuffficiency -Pulmonary ventilation

2.Strangulation

3.Gangrene

4.Perforation

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