LARGE BOWEL OBSTRUCTION
&
ACPO
LARGE BOWEL OBSTRUCTION
INTERRUPTION IN THE PASSAGE OF LARGE
INTESTINAL CONTENTS
CLASSIFICATION OF LBO
Depending on nature of obstruction
Depending on the blood supply
Depending Upon Presentation
Dependi...
DEPENDING ON THE NATURE OF
OBSTRUCTION
DYNAMIC OBSTRUCTION
• Carcinoma colon
• Volvulus
• Diverticulosis
• Intussusception...
DEPENDING ON THE BLOOD
SUPPLY
• Simple obstruction
• Strangulated obstruction
• Closed loop obstruction
DEPENDING UPON PRESENTATION
• Acute Obstruction : volvulus /obstructed
hernia
• Chronic obstruction : carcinoma colon /
di...
DEPENDING IN RELATION TO
LUMEN
• Outside the wall
• Inside the wall
• Inside the lumen-Foreign body,Fecal
impaction
DEPENDING IN RELATION TO LUMEN
OUTSIDE THE WALL
• Volvulus
• Hernias
• Tumour in adjacent organs
• Intra abdominal abscess...
MOST COMMON CAUSES OF LBO
• Colorectal cancer-65%
• Colonic volvulus-15%
• Diverticulitis-10%
• Others-10%
Hernia
Intussus...
MOST COMMON CAUSES OF LBO
PATHOGENESIS OF INTESTINAL
OBSTRUCTION
Changes proximal to bowel obstrucion
Changes at the site of obstruction
Closed loop...
CHANGES PROXIMAL TO BOWEL
OBSTRUCTION
Intestinal obstruction
Increased peristalsis
Vigorous peristalsis
If obstruction not...
Cessation Of Peristalsis
Flaccid, Paralysed Bowel
Dilated Bowel
CHANGES AT THE SITE OF
OBSTRUCTION
Intestinal obstruction
Distension
Venous compression
Congestion and edema
Progressive a...
Loss of shineness, Blackish discolouration
Loss of peristalsis
Gangrene & Perforation
Bacteria and toxins migrate into per...
CLOSED LOOP OBSTRUCTION
Growth in the right colon with competent
ileocaecal valve
Pressure increases in the caecum
Stercor...
CLINICAL FEATURES OF LARGE BOWEL
OBSTRUCTION
• Symptoms :
Abdominal Distension
Abdominal Pain
Obstipation
Vomiting
Nausea ...
SIGNS OF LARGE BOWEL
OBSTRUCTION
• General signs of dehydration
• Abdominal findings :
Distension
Tympanitic Note
Rt To Lt...
SIGNS OF STRANGULATION
Features of septic shock : fever/hypotension/
renal failure/respiratory signs
Rebound tenderness
Gu...
INVESTIGATIONS
• Blood : CBC / RBS / RFT / LFT / Electrolytes/ grouping
typing / ABG
• Imaging
1.upright chest x ray
2.sup...
MANAGEMENT OF LARGE BOWEL
OBSTRUCTION
Sun
should
not be
both rise
and set
PRINCIPLES
• Aspiration (ryles tube)
• Bowel care / blood transfusion
• Charts (temp,PR,RR,I/O,)/ critical care
• Drugs : ...
PRINCIPLES OF EXPLORATORY
LAPAROTOMY
• Ideally done 6 – 8 hrs
• Long midline incision
• Check viability of bowel – if not ...
FEATURES OF VIABLE BOWEL
• Normal peristalsis
• Normal peritoneal sheen is present
• Normal pulsation are visible or felt ...
IN DOUBTFUL VIABILITY
• Warm saline soaked mop is placed over the
doubtful areas with 100% oxygen for 10 min
if colour bec...
PRINCIPLES OF EXPLORATORY
LAPAROTOMY
• Ideally done 6 – 8 hrs
• Long midline incision
• Check viability of bowel – if not ...
COMPLICATIONS OF INTESTINAL
OBSTRUCTION
• Peritonitis
• Hypovolemia & septic shock
• Renal failure
• ARDS
• Intra abdomina...
POST SURGICAL COMPLICATIONS
• Pelvic abscess
• Subphrenic abscess
• Biliary or fecal fistula
• Burst abdomen
• Bands and a...
MANAGEMENT OF MALIGNANT
LARGE BOWEL OBSTRUCTION
• Primary goal: Decompression of obstructed
segment to prevent perforation...
OBSTRUCTING LESION OF THE RIGHT
COLON
Stable patient:
Resection And Ileotransvese
Anastomosis In Single Stage
OBSTRUCTING LESION OF THE RIGHT
COLON
• Unstable patient & bowel perforation
1st
stage:
Resection Of Lesion But No Primary...
OBSTRUCTING LESION OF THE RIGHT
COLON
Non - resectable lesion :
(Fixed To Posterior Abdominal Wall ,
Common Iliac Vessels)...
OBSTRUCTING LESION OF THE
TRANSVERSE COLON
• Treatment :
Extended Rt Hemicolectomy + Removal Of
Whole Omentum, Transverse ...
OBSTRUCTING LESIONS OF THE LEFT
COLON
Treatment options:
Three stage operation- Unstable Patient
Two stage operation- Unst...
THREE STAGE OPERATION
Transverse colostomy
After 3 – 6 weeks
Elective resection of tumour with an anastomosis
After 8 week...
TWO STAGE OPERATION
Hartmann’s Operation
After Six weeks
Restoration Of Bowel Continuity
SINGLE STAGE OPERATION
Stable Patient:
Left Hemicolectomy & Colorectal
Anastomosis
UNRESECTABLE LESION
External diversion: colostomy
Internal diversion: caecosigmoidostomy
COLONIC STENTS
Decompression Of The Obstruction
Emergency Situation Elective Setting
COLONIC STENTS
COLONIC VOLVULUS
SIGMOID VOLVULUS – 53%
CECAL VOLVULUS - <42%
TRANSVERSE COLON-3%
SPLENIC FLEXURE-2%
SIGMOID VOLVULUS
SIGMOID VOLVULUS
• Predisposing factors
Long mesentery of the pelvic colon
Narrow attachment at the base
Long, redundant a...
CLINICAL FEATURES OF SIGMOID
VOLVULUS
• Acute sigmoid volvulus
Abdominal pain
Absolute constipation
Abdominal distension-t...
CHRONIC RECURRENT SIGMOID VOLVULUS
• Clinical features
Recurrent left lower abdominal pain
Abdominal distension
Relieved b...
INVESTIGATIONS Contrast Enema
Bird’s beak sign
Bird of prey sign
Ace of spade sign
CT Abdomen
Whirl pattern
X- Ray Abd Ere...
SIGMOID VOLVULUS
INTRA-OPERATIVE INTRA-OPERATIVE
MANAGEMENT
• Non operative management
Resuscitation Endoscopic Decompression Using
Flatus Tube/Sigmoidoscopy/ Flexible Col...
Non operative management
NON OPERATIVE MANAGEMENT-FLATUS TUBE
OPERATIVE MANAGEMENT
If Bowel Is Gangrenous
Single Stage- Resection And End To End
Anastomosis
Hartmann’s Operation
Exteri...
COMPOUND VOLVULUS
Ileo SIgmoId KnottIng
Due To Presence Of Long Pelvic Mesocolon
Allows The Ileum To Twist Around The
Sigm...
COMPOUND VOLVULUS
ILEO SIGMOID KNOTTING
CECAL VOLVULUS
• Due to failure of fixation of the ileal and caecal
mesentery to the posterior abdominal wall
• Predisposi...
INVESTIGATIONS • Plain Xray Abdomen Erect
Comma Shaped Dilated
Ceacum In Left Upper
Abdomen
Single Long Fluid Level
Dilate...
CAECAL VOLVULUS
CAECAL VOLVULUS
MANAGEMENT
Right hemicolectomy with primary
anastomosis
Caecostomy/Caecopexy
Endoscopic decompression/derotation not
advis...
INTUSSUSCEPTION
• Defined as the Invagination of one segment of
intestine into the adjacent segment
• Types:
Antigrade:
Si...
Ileocolic-iss
PARTS OF INTUSSUSCEPTION
Intussuscipiens:Distal bowel which receives
the intestine
Intussusceptum:Proximal bowel which ent...
CAUSES OF INTUSSUSCEPTION
In Infants
Change in diet during
weaning period
Upper respiratory tract viral
infection
In Adult...
CLINICAL FEATURES OF
INTUSSUSCEPTION
Symptoms
Severe cramping abdominal
pain
Vomiting
Red current jelly stool
Signs
Sausag...
INVESTIGATIONS PlainX-ray:
Multiple air fluid levels
Barium enema:
Claw Sign Or
Coiled Spring Sign Or
Meniscus Sign
Ultras...
MANAGEMENT
• Non operative management:
Hydrostatic reduction
– Contrast enema
– Air enema
– Warm saline
Contraindications:...
SURGICAL MANAGEMENT OF ISS
• Laparotomy and reduction of intussusception
milking method
If Reduction possible If not possi...
SURGICAL MANAGEMENT OF ISS
• Laparotomy and reduction of intussusception
milking method
If Reduction possible If not possi...
ACUTE COLONIC PSEUDO
OBSTRUCTION-ACPO
• Defined as Massive Colonic Distension In The
Absence Of Mechanically Obstructing L...
SECONDARY PSEUDO
OBSTRUCTION
Smooth muscle disorders:
Collagen vascular disorders
Scleroderma,
Dermatomyositis
Muscular dy...
SECONDARY PSEUDO
OBSTRUCTION
Drugs- Phenothiazines, Tricyclic
antidepressants and opioids
Metabolic-Uremia, Hypokalemia, D...
CLINICAL FEATURES OF ACPO
Medically ill patient suddenly develops
abdominal distension
Tympanitic abdomen
Not tender
Bowel...
INVESTIGATIONS
• Plain Xray Abdomen Erect :
Shows Distension Of Colon
• Water Soluble Contrast Enema:IOC
Differentiates AC...
Plain Xray Abdomen Erect-acpo
MANAGEMENT
Non operative:
– Injection Neostigmine 2.5mg iv over 3 minutes
– Epidural anaesthesia
– Colonoscopic decompress...
THANK YOU
THANK U
Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college
Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college
Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college
Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college
Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college
Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college
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Large bowel obstruction -dr.p.saravanakumar ms pg tanjore medical college

  1. 1. LARGE BOWEL OBSTRUCTION & ACPO
  2. 2. LARGE BOWEL OBSTRUCTION INTERRUPTION IN THE PASSAGE OF LARGE INTESTINAL CONTENTS
  3. 3. CLASSIFICATION OF LBO Depending on nature of obstruction Depending on the blood supply Depending Upon Presentation Depending Upon In Relation To Lumen
  4. 4. DEPENDING ON THE NATURE OF OBSTRUCTION DYNAMIC OBSTRUCTION • Carcinoma colon • Volvulus • Diverticulosis • Intussusceptions • Adhesions ADYNAMIC OBSTRUCTION • Ogilvie’s syndrome • Toxic mega colon • Metabolic (hypokalemia) • Post-op ileus • Inflammatory disorder
  5. 5. DEPENDING ON THE BLOOD SUPPLY • Simple obstruction • Strangulated obstruction • Closed loop obstruction
  6. 6. DEPENDING UPON PRESENTATION • Acute Obstruction : volvulus /obstructed hernia • Chronic obstruction : carcinoma colon / diverticulosis • Acute on chronic obstruction : ca colon
  7. 7. DEPENDING IN RELATION TO LUMEN • Outside the wall • Inside the wall • Inside the lumen-Foreign body,Fecal impaction
  8. 8. DEPENDING IN RELATION TO LUMEN OUTSIDE THE WALL • Volvulus • Hernias • Tumour in adjacent organs • Intra abdominal abscess • Colonic obstructions INSIDE THE WALL • Carcinoma • Inflammation (diverticulosis,crohn’s disease,LGV,schistosomiasis ,TB) • Hirschsprung’s disease • Ischemia • Radiation • Intussusceptions • Anatomical stricture
  9. 9. MOST COMMON CAUSES OF LBO • Colorectal cancer-65% • Colonic volvulus-15% • Diverticulitis-10% • Others-10% Hernia Intussusceptions
  10. 10. MOST COMMON CAUSES OF LBO
  11. 11. PATHOGENESIS OF INTESTINAL OBSTRUCTION Changes proximal to bowel obstrucion Changes at the site of obstruction Closed loop obstruction Changes in the bowel distal to obstruction -Inactive and collapsed
  12. 12. CHANGES PROXIMAL TO BOWEL OBSTRUCTION Intestinal obstruction Increased peristalsis Vigorous peristalsis If obstruction not relieved Cessation of peristalsis
  13. 13. Cessation Of Peristalsis Flaccid, Paralysed Bowel Dilated Bowel
  14. 14. CHANGES AT THE SITE OF OBSTRUCTION Intestinal obstruction Distension Venous compression Congestion and edema Progressive arterial compromise
  15. 15. Loss of shineness, Blackish discolouration Loss of peristalsis Gangrene & Perforation Bacteria and toxins migrate into peritoneum Peritonitis
  16. 16. CLOSED LOOP OBSTRUCTION Growth in the right colon with competent ileocaecal valve Pressure increases in the caecum Stercoral ulcer in the caecum Gangrene&Perforation Fecal peritonitis
  17. 17. CLINICAL FEATURES OF LARGE BOWEL OBSTRUCTION • Symptoms : Abdominal Distension Abdominal Pain Obstipation Vomiting Nausea / Anorexia
  18. 18. SIGNS OF LARGE BOWEL OBSTRUCTION • General signs of dehydration • Abdominal findings : Distension Tympanitic Note Rt To Lt Colonic Peristalsis Borborygmi
  19. 19. SIGNS OF STRANGULATION Features of septic shock : fever/hypotension/ renal failure/respiratory signs Rebound tenderness Guarding / rigidity Absent bowel sounds Constant pain / severe pain Fever / tachycardia / leucocytosis
  20. 20. INVESTIGATIONS • Blood : CBC / RBS / RFT / LFT / Electrolytes/ grouping typing / ABG • Imaging 1.upright chest x ray 2.supine / upright abdominal x ray 3.barium enema (single/ double contrast) (gastrografin) 4.USG abdomen 5.CT with oral water soluble contrast / IV contrast / rectal contrast 6.colonoscopy / sigmoidoscopy
  21. 21. MANAGEMENT OF LARGE BOWEL OBSTRUCTION Sun should not be both rise and set
  22. 22. PRINCIPLES • Aspiration (ryles tube) • Bowel care / blood transfusion • Charts (temp,PR,RR,I/O,)/ critical care • Drugs : antibiotics • Exploratory laparotomy • Fluids : IVF
  23. 23. PRINCIPLES OF EXPLORATORY LAPAROTOMY • Ideally done 6 – 8 hrs • Long midline incision • Check viability of bowel – if not viable resection & anastomosis • Adhesion – release • Bands – divide • Volvulus – untwist / resection • Obstructed hernia – reduce • Stricture – resection / stricturoplasty
  24. 24. FEATURES OF VIABLE BOWEL • Normal peristalsis • Normal peritoneal sheen is present • Normal pulsation are visible or felt at mesentery • Normal pink colour is present
  25. 25. IN DOUBTFUL VIABILITY • Warm saline soaked mop is placed over the doubtful areas with 100% oxygen for 10 min if colour become normal with peristalsis Bowel is viable
  26. 26. PRINCIPLES OF EXPLORATORY LAPAROTOMY • Ideally done 6 – 8 hrs • Long midline incision • Check viability of bowel – if not viable resection & anastomosis • Adhesion – release • Bands – divide • Volvulus – untwist / resection • Obstructed hernia – reduce • Stricture – resection / stricturoplasty
  27. 27. COMPLICATIONS OF INTESTINAL OBSTRUCTION • Peritonitis • Hypovolemia & septic shock • Renal failure • ARDS • Intra abdominal abscess formation
  28. 28. POST SURGICAL COMPLICATIONS • Pelvic abscess • Subphrenic abscess • Biliary or fecal fistula • Burst abdomen • Bands and adhesion • Incisional hernia
  29. 29. MANAGEMENT OF MALIGNANT LARGE BOWEL OBSTRUCTION • Primary goal: Decompression of obstructed segment to prevent perforation • Secondary goal : Removal of the malignant lesion
  30. 30. OBSTRUCTING LESION OF THE RIGHT COLON Stable patient: Resection And Ileotransvese Anastomosis In Single Stage
  31. 31. OBSTRUCTING LESION OF THE RIGHT COLON • Unstable patient & bowel perforation 1st stage: Resection Of Lesion But No Primary Anastomosis Terminal Ileostomy And Transverse Colon Mucus Fistula 2nd Stage: Ileotransverse Anastomosis
  32. 32. OBSTRUCTING LESION OF THE RIGHT COLON Non - resectable lesion : (Fixed To Posterior Abdominal Wall , Common Iliac Vessels) Palliative: Ileotransverse Anastomosis Caecosigmoidostomy
  33. 33. OBSTRUCTING LESION OF THE TRANSVERSE COLON • Treatment : Extended Rt Hemicolectomy + Removal Of Whole Omentum, Transverse Colon+ Ileocolic Anastomosis (Distal Transverse Colon Or Proximal Descending Colon)
  34. 34. OBSTRUCTING LESIONS OF THE LEFT COLON Treatment options: Three stage operation- Unstable Patient Two stage operation- Unstable Patient Single stage operation- Stable Patient Sub total colectomy and ileorectal anastomosis - Unhealthy proximal colon
  35. 35. THREE STAGE OPERATION Transverse colostomy After 3 – 6 weeks Elective resection of tumour with an anastomosis After 8 weeks Colostomy closure
  36. 36. TWO STAGE OPERATION Hartmann’s Operation After Six weeks Restoration Of Bowel Continuity
  37. 37. SINGLE STAGE OPERATION Stable Patient: Left Hemicolectomy & Colorectal Anastomosis
  38. 38. UNRESECTABLE LESION External diversion: colostomy Internal diversion: caecosigmoidostomy
  39. 39. COLONIC STENTS Decompression Of The Obstruction Emergency Situation Elective Setting
  40. 40. COLONIC STENTS
  41. 41. COLONIC VOLVULUS SIGMOID VOLVULUS – 53% CECAL VOLVULUS - <42% TRANSVERSE COLON-3% SPLENIC FLEXURE-2%
  42. 42. SIGMOID VOLVULUS
  43. 43. SIGMOID VOLVULUS • Predisposing factors Long mesentery of the pelvic colon Narrow attachment at the base Long, redundant and pendulous sigmoid Loaded colon due to residue diet Diverticulitis with band/adhesions
  44. 44. CLINICAL FEATURES OF SIGMOID VOLVULUS • Acute sigmoid volvulus Abdominal pain Absolute constipation Abdominal distension-tympanitic abdomen Tyre like feel Features of peritonitis
  45. 45. CHRONIC RECURRENT SIGMOID VOLVULUS • Clinical features Recurrent left lower abdominal pain Abdominal distension Relieved by passage of large amount of flatus
  46. 46. INVESTIGATIONS Contrast Enema Bird’s beak sign Bird of prey sign Ace of spade sign CT Abdomen Whirl pattern X- Ray Abd Erect Omega sign Coffee bean sign Bent inner tube sign
  47. 47. SIGMOID VOLVULUS INTRA-OPERATIVE INTRA-OPERATIVE
  48. 48. MANAGEMENT • Non operative management Resuscitation Endoscopic Decompression Using Flatus Tube/Sigmoidoscopy/ Flexible Colonoscopy If Obstruction Relieved If Not Elective Surgery Emergency After One Week Laparotomy
  49. 49. Non operative management
  50. 50. NON OPERATIVE MANAGEMENT-FLATUS TUBE
  51. 51. OPERATIVE MANAGEMENT If Bowel Is Gangrenous Single Stage- Resection And End To End Anastomosis Hartmann’s Operation Exteriorisation Of Bowel If Bowel Is Not Gangrenous Single Stage- Resection and End To End Anastomosis Sigmoidopexy
  52. 52. COMPOUND VOLVULUS Ileo SIgmoId KnottIng Due To Presence Of Long Pelvic Mesocolon Allows The Ileum To Twist Around The Sigmoid Colon Presents As Acute Intestinal Obstruction X-ray : Dilated Both Ileal And Sigmoid Loops Treatment: Resuscitation Decompression f/b Resection And Anastomosis or Exteriorisation Of Bowel
  53. 53. COMPOUND VOLVULUS
  54. 54. ILEO SIGMOID KNOTTING
  55. 55. CECAL VOLVULUS • Due to failure of fixation of the ileal and caecal mesentery to the posterior abdominal wall • Predisposing factors: Previous surgery Pregnancy Obstructing lesion of left colon Malrotation
  56. 56. INVESTIGATIONS • Plain Xray Abdomen Erect Comma Shaped Dilated Ceacum In Left Upper Abdomen Single Long Fluid Level Dilated Small Bowel Right Of The Distended Caecum Contrast Enema: Tapering Of Ascending Colon CT Abdomen: Dilated Caecum With Fluid Level
  57. 57. CAECAL VOLVULUS
  58. 58. CAECAL VOLVULUS
  59. 59. MANAGEMENT Right hemicolectomy with primary anastomosis Caecostomy/Caecopexy Endoscopic decompression/derotation not advisable
  60. 60. INTUSSUSCEPTION • Defined as the Invagination of one segment of intestine into the adjacent segment • Types: Antigrade: Simple: Ileocolic, ileoileal, colocolic Compound: Ileoileocolic Retrograde: Jejunogastric intususception
  61. 61. Ileocolic-iss
  62. 62. PARTS OF INTUSSUSCEPTION Intussuscipiens:Distal bowel which receives the intestine Intussusceptum:Proximal bowel which enter into distal segment Apex:Is the part which advances Lead point
  63. 63. CAUSES OF INTUSSUSCEPTION In Infants Change in diet during weaning period Upper respiratory tract viral infection In Adults Intestinal polyps Submucous lipomas Meckel's diverticulum Carcinoma Leomyoma of intestine Purpuric submucosal haemorrhages-HSP
  64. 64. CLINICAL FEATURES OF INTUSSUSCEPTION Symptoms Severe cramping abdominal pain Vomiting Red current jelly stool Signs Sausage shaped mass in umbilical region Right iliac fossa empty Step ladder peristalsis Features of peritonitis PR shows blood stained mucus-Red current jelly
  65. 65. INVESTIGATIONS PlainX-ray: Multiple air fluid levels Barium enema: Claw Sign Or Coiled Spring Sign Or Meniscus Sign Ultrasound abdomen : – Target sign – Psuedokidney sign – Bull’s eye sign Doppler Study : To Check Blood Supply Of Bowel It Shows Mass With Doughnut Sign CT Abdomen  Target sign
  66. 66. MANAGEMENT • Non operative management: Hydrostatic reduction – Contrast enema – Air enema – Warm saline Contraindications: Perforation Profound shock and known pathological lesion
  67. 67. SURGICAL MANAGEMENT OF ISS • Laparotomy and reduction of intussusception milking method If Reduction possible If not possible check the viability & Resection and suture terminal ileum anastomosis to ascending colon
  68. 68. SURGICAL MANAGEMENT OF ISS • Laparotomy and reduction of intussusception milking method If Reduction possible If not possible check the viability & Resection and suture terminal ileum anastomosis to ascending colon
  69. 69. ACUTE COLONIC PSEUDO OBSTRUCTION-ACPO • Defined as Massive Colonic Distension In The Absence Of Mechanically Obstructing Lesion • Etiology: Primary pseudo-obstruction • Familial visceral myopathy • Sporadic visceral myopathy
  70. 70. SECONDARY PSEUDO OBSTRUCTION Smooth muscle disorders: Collagen vascular disorders Scleroderma, Dermatomyositis Muscular dystrophy- Myotonic dystrophy Amyloidosis Neurological disorders –Chaga's disease –Parkinsonism
  71. 71. SECONDARY PSEUDO OBSTRUCTION Drugs- Phenothiazines, Tricyclic antidepressants and opioids Metabolic-Uremia, Hypokalemia, Diabetes, Myxoedema, Hypoparathyroidism Viral infections
  72. 72. CLINICAL FEATURES OF ACPO Medically ill patient suddenly develops abdominal distension Tympanitic abdomen Not tender Bowel sounds present
  73. 73. INVESTIGATIONS • Plain Xray Abdomen Erect : Shows Distension Of Colon • Water Soluble Contrast Enema:IOC Differentiates ACPO From Mechanically Obstructing Lesions • Colonoscopy Not Advisable
  74. 74. Plain Xray Abdomen Erect-acpo
  75. 75. MANAGEMENT Non operative: – Injection Neostigmine 2.5mg iv over 3 minutes – Epidural anaesthesia – Colonoscopic decompression Operative: Emergency Laparotomy – If there is no ischemia or perforation-loop colostomy – If there is ischemia or perforation-Resection and ileostomy with mucus fistula
  76. 76. THANK YOU THANK U

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