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Large Bowel Obstruction

Large Bowel Obstruction. Introduction. Obstruction can be defined by it’s site in relation to lumen Extramural Adhesions Volvulus Intramural Tumours Inflammation Luminal Impacted faeces Foreign body . Introduction Continued. Obstruction can be further defined by:

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Large Bowel Obstruction

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  1. Large Bowel Obstruction

  2. Introduction Obstruction can be defined by it’s site in relation to lumen Extramural Adhesions Volvulus Intramural Tumours Inflammation Luminal Impacted faeces Foreign body

  3. Introduction Continued Obstruction can be further defined by: • Site in intestine. • Type- mechanical/non-mechanical • Rate of onset • Simple/strangulated/closed loop/partial/complete.

  4. Aetiology • Carcinoma • Diverticulitis • Volvulus • Megacolon and Faeces • Adhesions and Herniation • Pseudo-obstruction

  5. Clinical Findings • Colicky pain • Complete/incomplete constipation • Faeculent Vomiting • Weight loss, Appetite loss, Dehydration. • On examination: • Distension of the abdomen • Increased bowel sounds • Tenderness (note if tender and distended over the caecum). • Sucession Splash

  6. Investigations • Bloods • FBC • U&E’s • Amylase • Group and Save • CEA

  7. Investigations Continued • X-rays • Abnormal gas patterns • Gas proximal to obstruction. • Distended colon proximal to obstruction. • Perforation- gas below diaphragm.

  8. X-Rays

  9. Investigation Continued • Gastrographin Enema • Imaging- sigmoidoscopy, Colonoscopy, CT scan.

  10. Imaging- CT

  11. Management • IV resuscitation. • Nasogastric tube- to decompress, and if vomiting to avoid aspiration. • Analgesia • Consider antibiotics as prophylaxis against sepsis. • Surgical intervention- Laparotomy, Stenting, Resection. • Sigmoidoscopy for Volvulus.  • Conservative Treatment

  12. Course and Prognosis • Prognosis depends on the cause of obstruction. • Obstruction not associated with carcinoma (e.g. Diverticulitis) has a very good prognosis if treated. • Complications: • Perforation • Peritonitis

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