Colorectal Emergencies: Review and Controversies in the Management of Large Bowel Obstruction

Abstract

Introduction Traditionally, large bowel obstruction (LBO) has been managed as an operative emergency. Its causes and treatments are an important part of general surgical and colon and rectal surgery practices. Discussion While management has traditionally been emergent laparotomy with resection or removal of underlying pathology, newer methodologies and treatments over the last decade have required treating physicians to consider a number of other options, including nonoperative options such as stenting, when treating these patients. Conclusion Given these changes, treating a patient with LBO requires a thoughtful assessment and comprehensive understanding of underlying pathology, assessment of the patient's comorbidities and up-to-date knowledge of modern options for treatment.

Endometriosis: A Rare Cause of Large Bowel Obstruction

“…LBO is 4-5 times less common than small bowel obstruction, but it accounts for nearly 2-4% of all surgical admissions [2]. LBO occurs mainly in the elderly [1][2][3].…”

“…Nonneoplastic causes are relatively uncommon. Rare causes of obstruction include intussusception, Crohn disease, extrinsic tumors, fecal impaction, foreign body, infection, acute (toxic) or chronic megacolon, adhesion-related obstruction, and endometriosis [1][2][3].…”

Comparison between metallic stent and transanal decompression tube for malignant large-bowel obstruction

“…[1][2][3] Historically, malignant large-bowel obstruction (MLBO) has been managed as a life-threatening operative emergency, with morbidity rates of 30%-60% and mortality rates of 7%-22%. 2,4,5 These high morbidity and mortality rates after urgent surgery for MLBO are attributed to patients' poor general condition caused by factors such as dehydration, electrolyte imbalances, and concomitant diseases as well as by a poor intestinal condition caused by edema, dilatation, and decreased blood circulation, all of which may contribute to anastomotic failure.…”

Abdominal ultrasonography for patients with abdominal pain as a first-line diagnostic imaging modality

“…In the current study, bile duct cancer and sigmoid colon volvulus were not diagnosed using abdominal US due to the presence of intestinal gas. Sigmoid colon volvulus requires prompt diagnosis followed by surgical or endoscopic treatment (24). An upside down U-shaped loop of dilated bowel is a typical radiological finding (25).…”