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Related Experiment Videos

True and false large bowel obstruction.

K C Farmer, R K Phillips

    Bailliere'S Clinical Gastroenterology
    |September 1, 1991
    PubMed
    Summary
    This summary is machine-generated.

    Acute large bowel obstruction, caused by mechanical issues or motility problems (colonic pseudo-obstruction), requires prompt diagnosis. Distinguishing between these types impacts treatment, with contrast studies guiding surgical versus non-surgical management.

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    Area of Science:

    • Gastroenterology
    • Surgical Oncology
    • Colorectal Surgery

    Background:

    • Acute large bowel obstruction stems from mechanical causes like colorectal cancer or motility disturbances (colonic pseudo-obstruction).
    • Pathophysiology involves motility changes and increased colonic blood flow, potentially aiding tumor cell or bacterial spread.
    • Intravascular fluid depletion post-decompression has significant hemodynamic consequences.

    Purpose of the Study:

    • To elucidate the pathophysiology and clinical significance of acute large bowel obstruction.
    • To differentiate between mechanical obstruction and colonic pseudo-obstruction for appropriate management.
    • To outline optimal surgical and non-operative strategies for various large bowel obstructions.

    Main Methods:

    • Diagnosis often begins with plain abdominal X-ray.

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  • Water-soluble contrast studies are crucial for differentiating mechanical obstruction from pseudo-obstruction.
  • Surgical techniques discussed include extended right hemicolectomy, on-table irrigation, immediate anastomosis, colostomy, and Hartmann's procedure.

    • Main Results:

    • Mechanical obstruction typically necessitates surgery, while pseudo-obstruction is often managed non-surgically.
    • Endoscopic decompression shows high success rates for sigmoid volvulus but is not recommended for cecal volvulus.
    • Mortality in colonic volvulus correlates with bowel viability; pseudo-obstruction requires vigorous treatment of associated systemic conditions.

    Conclusions:

    • Accurate diagnosis via imaging and contrast studies is key to appropriate management of large bowel obstruction.
    • Optimizing patient condition with intensive care and timely surgery reduces mortality and morbidity.
    • Surgical and endoscopic interventions, tailored to obstruction type and location, are vital for favorable outcomes.