 Cancer (60%)
 Diverticulitis( 20 % )
 Volvulus (5%)
 Adhesions
 Hernia
 Fecal impaction
 Foreign body
 F. Body
 Bezoars
 Gall stone
 Food Particles
 A. lumbricoides
 Neoplasms
 Lipoma
 Polyps
 Hematoma
 Lymphoma
 Carcinoid
 Secondary Tumors
 TB Strictures
 Postoperative adhesions.
 Congenital adhesions
 Hernia
 Volvulus
1. Carcinoma:
The commonest cause that present with
obstruction.
2. Benign stricture:
Due to Diverticular disease, Ischemi...
According to Leplac’s law: maximum pressure
is at the it’s maximum diameter, Cecum is at
the greatest risk of perforation .
 Abdominal pain
 Distention
 Constipation
 Nausea
 Vomiting
 Proximal obstruction: early bilious vomiting.
 Distal obstruction:
constipation, distension, vomiting feculent
material...
 Past Medical Hx: remember to ask about
cardiac history (think about intestinal
ischemia), IBD, gallstones, cancer
 Meds...
Normal Scout :
 Always request:
Supine, Erect and CXR
 Gas pattern:
Gastric,Colonic and 1-2
small bowel
 Fluid Levels:
...
 look for free air under diaphragm, dilated
bowel loops, air-fluid levels.
 Note: if cecal diameter >12cm, there is a ri...
Large bowel
 Peripheral
 Max.diameter 8 cm .
 Presence of
haustration
 Colon is filled with
feces which has
bubbly app...
What are the radiological findings of large
bowel obstruction?
 Obstructed colon usually appears as a
peripherally locate...
How is bowel obstruction different from
paralytic ileus?
 There will be paucity of gas in bowel beyond
the site of obstru...
Barium enema radiograph
showing dilated colon. No
transition zone is visible
contrast (trip
Used with iv , oral and rectal contrast (triple contrast).
◦ The level and degree of obstruction .
◦ The ca...
 Diagnostic points :
◦ Abdominal plain films
 Inverted U-shaped appearance of distended sigmoid loop
 Loss of haustra
...
Ba contrast enema.contrast-
filled rectum illustrates the
"bird's beak" sign (white
arrow), corresponding to the
luminal n...
 20 year old woman presented to the ED with
12 hours of abdominal pain, nausea. and
vomiting low grade fever.
 No past s...
Dilated cecum
Cecum
Contrast
In Descending colon
Cecum
Barium Enema
Point of Obstruction
Ascending colon
Cecal volvulus
Coiled spring appearance with barium
enema.
Intussception
u/s abdomen
showing multiple
concentric rings of
increased and
decreased
echogenicity
Intussception
Barium enema: displacement
of the sigmoid colon by a
pelvic mass from
endometrial carcinoma
Barium radiograph demonstrates a
typical "apple-core" lesion (arrows)
caused by adenocarcinoma of the
small bowel, produci...
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
Large bowel obstruction
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Large bowel obstruction

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Large bowel obstruction

  1. 1.  Cancer (60%)  Diverticulitis( 20 % )  Volvulus (5%)  Adhesions  Hernia  Fecal impaction  Foreign body
  2. 2.  F. Body  Bezoars  Gall stone  Food Particles  A. lumbricoides
  3. 3.  Neoplasms  Lipoma  Polyps  Hematoma  Lymphoma  Carcinoid  Secondary Tumors  TB Strictures
  4. 4.  Postoperative adhesions.  Congenital adhesions  Hernia  Volvulus
  5. 5. 1. Carcinoma: The commonest cause that present with obstruction. 2. Benign stricture: Due to Diverticular disease, Ischemia, Inflammatory bowel disease. 3. Volvulus: Results from long redundant, faecaly loaded colon with a narrow pedicle. 4. Hernia.
  6. 6. According to Leplac’s law: maximum pressure is at the it’s maximum diameter, Cecum is at the greatest risk of perforation .
  7. 7.  Abdominal pain  Distention  Constipation  Nausea  Vomiting
  8. 8.  Proximal obstruction: early bilious vomiting.  Distal obstruction: constipation, distension, vomiting feculent material (bacterial overgrowth of contents).  Distal obstruction: Less acute onset. Less prominent .
  9. 9.  Past Medical Hx: remember to ask about cardiac history (think about intestinal ischemia), IBD, gallstones, cancer  Meds: narcotics,antipsychotics (ileus), diuretics (hypoK / ileus)  recent weight loss (CA).
  10. 10. Normal Scout :  Always request: Supine, Erect and CXR  Gas pattern: Gastric,Colonic and 1-2 small bowel  Fluid Levels:  Free gas under diaphragm  Look for calcification  Look for soft tissue masses.
  11. 11.  look for free air under diaphragm, dilated bowel loops, air-fluid levels.  Note: if cecal diameter >12cm, there is a risk of perforation.  Barium enema  Bowel follow-through  CT scan- with PO/IV contrast
  12. 12. Large bowel  Peripheral  Max.diameter 8 cm .  Presence of haustration  Colon is filled with feces which has bubbly appearance  Air fluid levels are few and large. Small Bowel  Central  Max. diameter 5 cm.  Vulvulae coniventae  Air fluid levels are many and small .
  13. 13. What are the radiological findings of large bowel obstruction?  Obstructed colon usually appears as a peripherally located distended bowel with haustral markings.  No air distal to site of obstruction.  Sometimes the mass may be seen.
  14. 14. How is bowel obstruction different from paralytic ileus?  There will be paucity of gas in bowel beyond the site of obstruction, unlike in paralytic ileus where gas can be seen in the rectum.
  15. 15. Barium enema radiograph showing dilated colon. No transition zone is visible
  16. 16. contrast (trip Used with iv , oral and rectal contrast (triple contrast). ◦ The level and degree of obstruction . ◦ The cause: volvulus, hernia, luminal and mural causes ◦ The degree of ischaemia ◦ Free fluid and gas ◦ Able to demonstrate abnormality in the bowel wall, mesentery, mesenteric vessels and peritoneum. Ensure: patient vitally stable with no renal failure and no previous allergy to iodine iodine
  17. 17.  Diagnostic points : ◦ Abdominal plain films  Inverted U-shaped appearance of distended sigmoid loop  Loss of haustra  Coffee-bean sign à midline crease corresponding to mesenteric root in a greatly distended sigmoid  Sigmoid volvulus – bowel loop points to RUQ  Cecal volvulus – bowel loop points to LUQ  Bird’s-beak or bird-of-prey sign à seen on barium enema in sigmoid volvulus as it encounters the volvulated loop  Apple core appearance : ca colon.
  18. 18. Ba contrast enema.contrast- filled rectum illustrates the "bird's beak" sign (white arrow), corresponding to the luminal narrowing at the site of sigmoid obstruction. This is the characteristic presentation of a sigmoid volvulus
  19. 19.  20 year old woman presented to the ED with 12 hours of abdominal pain, nausea. and vomiting low grade fever.  No past surgical history  PMH: Polycystic ovarian disease
  20. 20. Dilated cecum
  21. 21. Cecum
  22. 22. Contrast In Descending colon Cecum
  23. 23. Barium Enema Point of Obstruction Ascending colon
  24. 24. Cecal volvulus
  25. 25. Coiled spring appearance with barium enema. Intussception
  26. 26. u/s abdomen showing multiple concentric rings of increased and decreased echogenicity Intussception
  27. 27. Barium enema: displacement of the sigmoid colon by a pelvic mass from endometrial carcinoma
  28. 28. Barium radiograph demonstrates a typical "apple-core" lesion (arrows) caused by adenocarcinoma of the small bowel, producing a partial obstruction with dilated proximal bowel.

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