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: cancer Other 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.
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. Withprogression, the arterial blood supply becomes disturbed with mucosal ulceration This results in ischaemia, necrosis, and perforation.
INVESTIGATIONS1 ) Flat and upright Abdominal x-ray show distended bowel2) CT Scan to assess the cause of the obstruction3) Gastrografin to provide contrast than barium when bowel obstruction is suspected4 ) Barium enema to confirm diagnosis of large bowel obstruction5 ) Blood investigation evaluate presence of infection & fluid and electrolyte imbalance WBC - high due to inflammatory response
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) Ifobstruction was caused by adhesion – removed or lysed. If tumours are found- resected. If foreign bodies are found- removed.